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General NPI Number Information
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NPI Number | 1407036189
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Entity Type | Organization
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Legal Business Name | COTTONTREE FAMILY PRACTICE
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2230 N UNIVERSITY PKWY SUITE 1A
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City | PROVO
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State | UT
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Zip | 84604-1509
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Country | US
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Telephone | 801-377-3413
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Fax | 801-655-1890
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Provider Business Mailing Address
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Address Line | 2230 N UNIVERSITY PKWY SUITE 1A
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City | PROVO
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State | UT
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Zip | 84604-1509
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Country | US
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Telephone | 801-377-3413
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Fax | 801-655-1890
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Authorized Official
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Title or Position | MANAGER
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Name | SHAUNA MANHART
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Credential |
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Telephone | 801-377-3413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | UT
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