MEDICARE: HARBOR AMPUTATION REHABILITATION & ADAPTIVE TRAINING

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	261QA0900X	Amputee Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1477315232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR AMPUTATION REHABILITATION & ADAPTIVE TRAINING

Provider Business Mailing Address
First Line	:	515 S 700 E STE 2F
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S 700 E STE 2F
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2886
Country	:	US
Telephone Number	:	801-828-8105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAIR HELENEK
Credential	:	PT, DPT
Telephone Number	:	801-828-8105

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/22/2025

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