| NPI | 1790402170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MANGUM CEO 801-410-0205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine |
| 2080S0010X Pediatrics, Sports Medicine | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 2083S0010X Preventive Medicine, Sports Medicine | |
| 2251S0007X Physical Therapist, Sports | |
| 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine | |
| 207PS0010X Emergency Medicine, Sports Medicine | |
| 207QS0010X Family Medicine, Sports Medicine | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |