Healthcare Provider Details

I. General information

NPI: 1811642739
Provider Name (Legal Business Name): PACIFIC THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E BIGELOW AVE
LAYTON UT
84040-5753
US

IV. Provider business mailing address

1027 E BIGELOW AVE
LAYTON UT
84040-5753
US

V. Phone/Fax

Practice location:
  • Phone: 385-321-4714
  • Fax:
Mailing address:
  • Phone: 385-321-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEKELL SMITH
Title or Position: PRINCIPAL
Credential: MS, CCC-SLP
Phone: 385-321-4714