Healthcare Provider Details

I. General information

NPI: 1013053933
Provider Name (Legal Business Name): UNIVERSITY OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

PO BOX 510721
SALT LAKE CITY UT
84151-0721
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-587-6872
  • Fax: 801-587-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number3205762401
License Number StateUT

VIII. Authorized Official

Name: AMY FRAME
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 801-943-4125