Healthcare Provider Details

I. General information

NPI: 1053175976
Provider Name (Legal Business Name): WASATCH RPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 HARRISON BLVD
OGDEN UT
84403-4316
US

IV. Provider business mailing address

5825 HARRISON BLVD
OGDEN UT
84403-4316
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5254
  • Fax: 801-797-0278
Mailing address:
  • Phone: 801-475-5254
  • Fax: 801-797-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH FYANS
Title or Position: OWNER
Credential:
Phone: 801-475-5254