Healthcare Provider Details

I. General information

NPI: 1528460482
Provider Name (Legal Business Name): PEAK HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N 2000 W #203
FARR WEST UT
84404-9219
US

IV. Provider business mailing address

2850 N 2000 W #203
FARR WEST UT
84404-9219
US

V. Phone/Fax

Practice location:
  • Phone: 801-689-3389
  • Fax: 801-689-2320
Mailing address:
  • Phone: 801-689-3389
  • Fax: 801-689-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number6801881-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number46D2083659
License Number StateUT

VIII. Authorized Official

Name: BRYAN HAINSWORTH
Title or Position: PRESIDENT
Credential: PA-C
Phone: 801-689-3389