Healthcare Provider Details

I. General information

NPI: 1669935292
Provider Name (Legal Business Name): LISTON PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 S COLLEGE DR STE 103
MURRAY UT
84123-2959
US

IV. Provider business mailing address

5292 S COLLEGE DR STE 103
MURRAY UT
84123-2959
US

V. Phone/Fax

Practice location:
  • Phone: 385-425-3960
  • Fax: 385-425-3965
Mailing address:
  • Phone: 385-425-3960
  • Fax: 385-425-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES WILLIAM LISTON
Title or Position: CERTIFIED PROSTHETIST
Credential: CP
Phone: 385-425-3960