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General NPI Number Information
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NPI Number | 1720363898
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Entity Type | Organization
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Legal Business Name | CUSTOM SPECIALTY REHAB
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 5820 W 3800 S
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City | HOOPER
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State | UT
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Zip | 84315-9803
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Country | US
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Telephone | 801-781-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 W 3800 S
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City | HOOPER
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State | UT
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Zip | 84315-9803
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT CHRISTIAN PAULSEN
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Credential |
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Telephone | 801-781-0084
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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