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General NPI Number Information
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NPI Number | 1073261004
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN HEALTHCARE
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 5121 S COTTONWOOD ST
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City | MURRAY
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State | UT
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Zip | 84107-5701
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Country | US
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Telephone | 801-507-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 E 900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1333
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Country | US
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Telephone | 801-450-0736
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Fax |
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Authorized Official
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Title or Position | PT
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Name | DANA DENTON
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Credential | PT
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Telephone | 801-450-0736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number |
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License Number State |
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