Healthcare Provider Details

I. General information

NPI: 1366122236
Provider Name (Legal Business Name): HOLYOAK SPORTS PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N 1500 W STE A
OREM UT
84057-2829
US

IV. Provider business mailing address

2072 N RED YEARLING DR
SARATOGA SPRINGS UT
84045-3949
US

V. Phone/Fax

Practice location:
  • Phone: 385-283-1265
  • Fax:
Mailing address:
  • Phone: 630-699-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LARSEN HOLYOAK
Title or Position: OWNER
Credential: DPT
Phone: 385-283-1265