MEDICARE: CARA C CAMIOLO REDDY MD

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	208100000X	Physical Medicine & Rehabilitation Physician	9826719-1205	UT
2	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	9826719-1205	UT

General Provider Information

NPI Number	:	1679519961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA C CAMIOLO REDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-507-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5171 S COTTONWOOD ST
Second Line	:	STE 810
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5704
Country	:	US
Telephone Number	:	801-507-9800
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/04/2020

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