Healthcare Provider Details

I. General information

NPI: 1073261004
Provider Name (Legal Business Name): INTERMOUNTAIN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1771 E 900 S
SALT LAKE CITY UT
84108-1333
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7510
  • Fax:
Mailing address:
  • Phone: 801-450-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANA DENTON
Title or Position: PT
Credential: PT
Phone: 801-450-0736