Healthcare Provider Details

I. General information

NPI: 1821513755
Provider Name (Legal Business Name): SARAH HUPPI ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 SFH
PROVO UT
84602
US

IV. Provider business mailing address

9264 S MOUNTAIN IRIS WAY
WEST JORDAN UT
84081-6150
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-5725
  • Fax:
Mailing address:
  • Phone: 435-760-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number98704724810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: