Healthcare Provider Details
I. General information
NPI: 1376453662
Provider Name (Legal Business Name): REGENERATION HEALTH OF NORTHERN UTAH
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2797 N HWY 89 STE 100
PLEASANT VIEW UT
84404-1231
US
IV. Provider business mailing address
2797 N HWY 89 STE 100
PLEASANT VIEW UT
84404-1231
US
V. Phone/Fax
- Phone: 801-528-5392
- Fax: 801-782-6801
- Phone: 801-528-5392
- Fax: 801-782-6801
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207QA0505X |
| Taxonomy | Adult Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
GENE
CODY
SASE
Title or Position: OWNER
Credential: FNP
Phone: 801-528-5392