Healthcare Provider Details

I. General information

NPI: 1477817443
Provider Name (Legal Business Name): BETSY REESE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E KIMBALLS LN STE 207
DRAPER UT
84020-5025
US

IV. Provider business mailing address

PO BOX 100253
ATLANTA GA
30384-0253
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-2300
  • Fax: 844-249-1746
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number11082695-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: