Healthcare Provider Details

I. General information

NPI: 1417234766
Provider Name (Legal Business Name): AMERICAN WELLNESS & REHAB CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 W 5300 S
MURRAY UT
84123-5671
US

IV. Provider business mailing address

677 W 5300 S
MURRAY UT
84123-5671
US

V. Phone/Fax

Practice location:
  • Phone: 801-327-8700
  • Fax: 801-290-2847
Mailing address:
  • Phone: 801-327-8700
  • Fax: 801-290-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET OWEN
Title or Position: MEMBER
Credential:
Phone: 801-327-8700