Healthcare Provider Details

I. General information

NPI: 1487581096
Provider Name (Legal Business Name): ELIZABETH MARIE MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S WAKARA WAY
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

494 INVERNESS LN
HEBER CITY UT
84032-1455
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7109
  • Fax:
Mailing address:
  • Phone: 763-452-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: