Healthcare Provider Details

I. General information

NPI: 1477315232
Provider Name (Legal Business Name): HARBOR AMPUTATION REHABILITATION & ADAPTIVE TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 700 E STE 2F
SALT LAKE CITY UT
84102-2886
US

IV. Provider business mailing address

515 S 700 E STE 2F
SALT LAKE CITY UT
84102-2886
US

V. Phone/Fax

Practice location:
  • Phone: 801-828-8105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAIR HELENEK
Title or Position: OWNER
Credential: PT, DPT
Phone: 801-828-8105