Healthcare Provider Details

I. General information

NPI: 1740884907
Provider Name (Legal Business Name): REBORN PELVIC HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S FASHION BLVD STE 101
MURRAY UT
84107-5416
US

IV. Provider business mailing address

6040 S FASHION BLVD STE 101
MURRAY UT
84107-5416
US

V. Phone/Fax

Practice location:
  • Phone: 801-702-8475
  • Fax:
Mailing address:
  • Phone: 801-702-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH DELASS
Title or Position: OWNER/CEO
Credential:
Phone: 801-702-8475