MEDICARE: ADANNA FOLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12690084-2401	UT

General Provider Information

NPI Number	:	1588310783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADANNA FOLEY

Provider Business Mailing Address
First Line	:	1412 E KOMENDA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 E KOMENDA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1465
Country	:	US
Telephone Number	:	801-258-1563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	02/25/2022

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Directions to “ ADANNA FOLEY ” Practice Location

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