Healthcare Provider Details

I. General information

NPI: 1629912647
Provider Name (Legal Business Name): TIMOTHY STEPHEN BUMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E 100 S
SALT LAKE CITY UT
84102-4107
US

IV. Provider business mailing address

750 E 100 S
SALT LAKE CITY UT
84102-4107
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-9728
  • Fax:
Mailing address:
  • Phone: 801-328-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: