Healthcare Provider Details

I. General information

NPI: 1720517279
Provider Name (Legal Business Name): CARLY CHRISTINE SACCO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S 300 E
MURRAY UT
84107-6157
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4040
  • Fax:
Mailing address:
  • Phone: 801-314-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10968923-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: