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General NPI Number Information
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NPI Number | 1326535915
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Entity Type | Organization
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Legal Business Name | INJURY CLINIC, LLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 10456 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 804-446-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 10456 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 804-446-5100
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. R JAY SHETLIN
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Credential |
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Telephone | 801-446-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | UT
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