| NPI | 1891455895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPENCER CLARK Owner 801-980-1595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 208D00000X General Practice |
| 213E00000X Podiatrist | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician | |
| Enumeration Date | 2021-12-19 |
| Last Update Date | 2025-08-29 |