MEDICARE: ABILITYBOOST, LLC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326332107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABILITYBOOST, LLC

Provider Business Mailing Address
First Line	:	2761 E 4135 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3039
Country	:	US
Telephone Number	:	801-438-4444
Fax Number	:	801-618-2688

Provider Business Practice Location Address
First Line	:	2761 E 4135 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3039
Country	:	US
Telephone Number	:	801-438-4444
Fax Number	:	801-618-2688

Authorized Official
Title or Position	:	PARTNER
Name	:	CHARLES DREW HYDE
Credential	:
Telephone Number	:	801-438-4444

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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