Healthcare Provider Details

I. General information

NPI: 1023299591
Provider Name (Legal Business Name): PM&R COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY MEDICAL CENTER PMR 30 NO. 1900 EAST
SALT LAKE CITY UT
84132-2119
US

IV. Provider business mailing address

UNIVERSITY MEDICAL CENTER PMR 30 NO. 1900 EAST
SALT LAKE CITY UT
84132-2119
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-5741
  • Fax: 801-585-5757
Mailing address:
  • Phone: 801-581-5741
  • Fax: 801-585-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number StateUT

VIII. Authorized Official

Name: DR. D. CORYDON HAMMOND
Title or Position: CO-DIRECTOR
Credential: PH.D.
Phone: 801-581-5741