Healthcare Provider Details

I. General information

NPI: 1679630032
Provider Name (Legal Business Name): ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N. 400 E
LOGAN UT
84341
US

IV. Provider business mailing address

102 WOODMONT BLVD SUITE 120
NASHVILLE TN
37205
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-5100
  • Fax: 435-753-5105
Mailing address:
  • Phone: 615-550-8774
  • Fax: 615-454-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD GARDNER
Title or Position: VP, COO
Credential:
Phone: 615-550-8760