Healthcare Provider Details

I. General information

NPI: 1205743432
Provider Name (Legal Business Name): MCKENNA WISCOMBE HARRIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 W 800 N STE 110
OREM UT
84057-3658
US

IV. Provider business mailing address

684 W 800 N STE 110
OREM UT
84057-3658
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-2250
  • Fax: 801-224-2655
Mailing address:
  • Phone: 801-224-2250
  • Fax: 801-224-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14289795-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: