Healthcare Provider Details

I. General information

NPI: 1033077516
Provider Name (Legal Business Name): JOSH HOLMGREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S GENEVA RD
OREM UT
84058-5857
US

IV. Provider business mailing address

11472 S 3420 W
SOUTH JORDAN UT
84095-8159
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-4636
  • Fax:
Mailing address:
  • Phone: 801-556-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: