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General NPI Number Information
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NPI Number | 1447601299
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Entity Type | Organization
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Legal Business Name | INJURY TREATMENT CENTER OF AMERICA MURRAY INC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 279 EAST 5900 SOUTH SUITE 102
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-904-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 279 EAST 5900 SOUTH SUITE 102
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-904-3930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK ORMOND
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Credential |
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Telephone | 801-856-6368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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