Healthcare Provider Details

I. General information

NPI: 1962529008
Provider Name (Legal Business Name): QUANTUM INJURY AND PAIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 E 9400 S SUITE 100
SANDY UT
84094-3666
US

IV. Provider business mailing address

9601 GARNET DR
SANDY UT
84094-3661
US

V. Phone/Fax

Practice location:
  • Phone: 801-553-9966
  • Fax: 801-553-9949
Mailing address:
  • Phone: 801-651-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number213662-4701
License Number StateUT

VIII. Authorized Official

Name: KATHERIN MINER
Title or Position: MEDICAL MASSAGE THERAPIST
Credential: LMT
Phone: 801-651-9263