Healthcare Provider Details

I. General information

NPI: 1023298999
Provider Name (Legal Business Name): SUMMIT HAND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2179 N 1700 W SUITE 5
LAYTON UT
84041-1138
US

IV. Provider business mailing address

2179 N 1700 W SUITE 5
LAYTON UT
84041-1138
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-2633
  • Fax: 801-773-1553
Mailing address:
  • Phone: 801-773-2633
  • Fax: 801-773-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6717526-4201
License Number StateUT

VIII. Authorized Official

Name: SAMUEL J DELONG
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 801-773-2633