Healthcare Provider Details

I. General information

NPI: 1659748952
Provider Name (Legal Business Name): CANYON FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2015
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 KIRBY LN STE D
SPANISH FORK UT
84660-1368
US

IV. Provider business mailing address

83 E 1200 N
MAPLETON UT
84664-3710
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-4743
  • Fax: 801-804-5545
Mailing address:
  • Phone: 801-609-4743
  • Fax: 801-804-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number93570600501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number93570600501
License Number StateUT

VIII. Authorized Official

Name: LEVI BERRY
Title or Position: OWNER
Credential: DPM
Phone: 801-609-4743