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NPI Code Detail

MEDICARE: MOUNTAIN LAND OUTPATIENT SERVICES

MEDICARE: MOUNTAIN LAND OUTPATIENT SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1255493672
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN LAND OUTPATIENT SERVICES
Provider Business Mailing Address
First Line : 1952 E 7000 S
Second Line : SUITE 100
City : SALT LAKE CITY
State : UT
Zip : 84121-6877
Country : US
Telephone Number : 801-942-3311
Fax Number : 801-942-5955
Provider Business Practice Location Address
First Line : 1952 E 7000 S
Second Line : SUITE 100
City : SALT LAKE CITY
State : UT
Zip : 84121-6877
Country : US
Telephone Number : 801-942-3311
Fax Number : 801-942-5955
Authorized Official
Title or Position : PRESIDENT OWNER
Name : MR. MARK A. ANDERSON
Credential : PT
Telephone Number : 801-942-3311
Provider Enumeration Date : 12/14/2006
Last Update Date : 11/16/2010

Similar Medicare Providers

1174671895 — RANDI BELL SLP
Practice Location Address:
1952 FORT UNION BLVD , SUITE 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax: 801-942-5955
1467598854 — MS. SHARON AMY VINICK SLP-CCC
Practice Location Address:
1952 FORT UNION BLVD , SUITE 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax:
1568508828 — MRS. CHERISH E LLOYD OTRL
Practice Location Address:
1952 FORT UNION BLVD , SUITE 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax: 801-942-5955
1871631754 — AARON SCOTT LEWIS MPT
Practice Location Address:
1952 FORT UNION BLVD , SUITE 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax: 801-942-5955
1649319096 — KENNETH COSTA
Practice Location Address:
1952 FORT UNION BLVD , # 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax: 801-942-5955
1104969773 — HEATHER DIANE RICHERSON PHYSICAL THERAPIST
Practice Location Address:
1952 FORT UNION BLVD , SUITE 100
SALT LAKE CITY, UT
84121-6877
Practice Phone: 801-942-3311
Practice Fax:

Directions to “MOUNTAIN LAND OUTPATIENT SERVICES ” Practice Location

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