Healthcare Provider Details

I. General information

NPI: 1326665829
Provider Name (Legal Business Name): WASATCH WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 S 900 E STE 100
MURRAY UT
84117-5731
US

IV. Provider business mailing address

1427 E HOWARDS WAY
FRUIT HEIGHTS UT
84037-5301
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-8896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON KETCHER
Title or Position: OWNER
Credential: DNP, FNP-C, CRNA
Phone: 480-215-9003