Healthcare Provider Details

I. General information

NPI: 1376810176
Provider Name (Legal Business Name): ACTIJOINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 S STATE ST SUITE 110
DRAPER UT
84020-7155
US

IV. Provider business mailing address

11762 S STATE ST SUITE 110
DRAPER UT
84020-7155
US

V. Phone/Fax

Practice location:
  • Phone: 801-495-3539
  • Fax: 801-996-8785
Mailing address:
  • Phone: 801-390-0188
  • Fax: 801-996-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number6453925-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RYAN K RIGGS
Title or Position: OWNER
Credential: MD
Phone: 801-651-4876