Healthcare Provider Details

I. General information

NPI: 1164383733
Provider Name (Legal Business Name): HEATHER TAYLOR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 210
VINEYARD UT
84059-7510
US

IV. Provider business mailing address

804 S 1730 W
OREM UT
84059-4919
US

V. Phone/Fax

Practice location:
  • Phone: 801-877-7608
  • Fax:
Mailing address:
  • Phone: 801-602-9371
  • Fax: 801-602-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7413081-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: