Healthcare Provider Details

I. General information

NPI: 1689184053
Provider Name (Legal Business Name): MIRANDA GREER ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 SFH
PROVO UT
84602-2246
US

IV. Provider business mailing address

723 E 230 N
LINDON UT
84042-2521
US

V. Phone/Fax

Practice location:
  • Phone: 801-362-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number9875115
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: