Healthcare Provider Details

I. General information

NPI: 1023830841
Provider Name (Legal Business Name): MATTHEW BEACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 E FORT UNION BLVD STE 101
COTTONWOOD HEIGHTS UT
84121-2868
US

IV. Provider business mailing address

1300 HOBBLE CREEK DR
SPRINGVILLE UT
84663-2854
US

V. Phone/Fax

Practice location:
  • Phone: 385-526-3945
  • Fax:
Mailing address:
  • Phone: 801-703-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8052147-2402
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8052147-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: