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General NPI Number Information
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NPI Number | 1538549993
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Entity Type | Organization
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Legal Business Name | REDWOOD INJURY TREATMENT CENTER INC.
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 6321 S REDWOOD RD SUITE 105
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-6798
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Country | US
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Telephone | 801-904-3089
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Fax |
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Provider Business Mailing Address
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Address Line | 44 UNION BLVD SUITE 125
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City | LAKEWOOD
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State | CO
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Zip | 80228-1856
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Country | US
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Telephone | 303-330-0024
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 7376354-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 352304-1205
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License Number State | UT
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