Healthcare Provider Details

I. General information

NPI: 1205506847
Provider Name (Legal Business Name): SOUTH VALLEY ORTHOMED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 W 930 N STE C
PLEASANT GROVE UT
84062-4132
US

IV. Provider business mailing address

1988 W 930 N STE C
PLEASANT GROVE UT
84062-4132
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-4242
  • Fax: 801-987-3493
Mailing address:
  • Phone: 801-566-4242
  • Fax: 801-987-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER STRONG
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 801-566-4242