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General NPI Number Information
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NPI Number | 1457752503
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Entity Type | Organization
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Legal Business Name | EAZE BRACING
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 1324 W 7125 S
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City | WEST JORDAN
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State | UT
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Zip | 84084
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Country | US
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Telephone | 801-834-2185
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 W 7125 S
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City | WEST JORDAN
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State | UT
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Zip | 84084
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Country | US
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Telephone | 801-834-2185
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARCY HECK
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Credential |
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Telephone | 801-834-2185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 41085
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License Number State | UT
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