Healthcare Provider Details

I. General information

NPI: 1851686588
Provider Name (Legal Business Name): WALKING COMFORT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 W. MARKETPLACE DR.
CENTERVILLE UT
84014-0000
US

IV. Provider business mailing address

627 W. MARKETPLACE DR.
CENTERVILLE UT
84014-0000
US

V. Phone/Fax

Practice location:
  • Phone: 801-872-3338
  • Fax:
Mailing address:
  • Phone: 801-872-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number13310322-004-STC
License Number StateUT

VIII. Authorized Official

Name: MR. BRYCE M ANDERSON
Title or Position: OWNER
Credential:
Phone: 801-872-3338