Healthcare Provider Details

I. General information

NPI: 1114077559
Provider Name (Legal Business Name): CHRISTOPHER MARK REYNOLDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 ROBINS DR
LAYTON UT
84041-1140
US

IV. Provider business mailing address

587 S 900 E
LAYTON UT
84041-4415
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-7060
  • Fax: 801-774-6100
Mailing address:
  • Phone: 801-544-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: