Healthcare Provider Details

I. General information

NPI: 1528399573
Provider Name (Legal Business Name): MERIDIAN REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 400 E
BOUNTIFUL UT
84010-4938
US

IV. Provider business mailing address

450 S 400 E
BOUNTIFUL UT
84010-4938
US

V. Phone/Fax

Practice location:
  • Phone: 801-296-5113
  • Fax: 801-693-2424
Mailing address:
  • Phone: 801-296-5113
  • Fax: 801-693-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: BRETT ROBERTSON
Title or Position: PRESIDENT
Credential:
Phone: 801-296-5113