Healthcare Provider Details

I. General information

NPI: 1538853700
Provider Name (Legal Business Name): MID-VALLEY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 S COLLEGE DR STE 200
MURRAY UT
84123-2918
US

IV. Provider business mailing address

1988 W 930 N STE D
PLEASANT GROVE UT
84062-4132
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-4242
  • Fax: 801-987-3493
Mailing address:
  • Phone: 801-566-4242
  • Fax: 801-987-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NATHAN DEE MILLER
Title or Position: CEO
Credential: DC
Phone: 801-566-4242