Healthcare Provider Details

I. General information

NPI: 1689788762
Provider Name (Legal Business Name): UTAH PAIN & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 WALL AVE STE 1
OGDEN UT
84404-5673
US

IV. Provider business mailing address

1276 WALL AVE STE 1
OGDEN UT
84404-5673
US

V. Phone/Fax

Practice location:
  • Phone: 801-337-4000
  • Fax: 801-337-4002
Mailing address:
  • Phone: 801-337-4000
  • Fax: 801-337-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number347196-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERY MARCHESE
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-337-4000