Healthcare Provider Details

I. General information

NPI: 1457752503
Provider Name (Legal Business Name): EAZE BRACING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W 7125 S
WEST JORDAN UT
84084
US

IV. Provider business mailing address

1324 W 7125 S
WEST JORDAN UT
84084
US

V. Phone/Fax

Practice location:
  • Phone: 801-834-2185
  • Fax:
Mailing address:
  • Phone: 801-834-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number41085
License Number StateUT

VIII. Authorized Official

Name: DARCY HECK
Title or Position: PRESIDENT
Credential:
Phone: 801-834-2185