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General NPI Number Information
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NPI Number | 1457954406
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Entity Type | Organization
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Legal Business Name | ALL STAR THERAPY
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 1112 W 4175 S
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City | RIVERDALE
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State | UT
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Zip | 84405-2633
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Country | US
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Telephone | 732-983-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 W 4175 S
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City | RIVERDALE
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State | UT
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Zip | 84405-2633
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Country | US
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Telephone | 732-983-1178
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIAN REY GRAN
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Credential |
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Telephone | 732-983-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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