MEDICARE: GOAL PEDIATRIC ORTHOTICS 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1699304089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOAL PEDIATRIC ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	471 E 1000 S STE D
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3694
Country	:	US
Telephone Number	:	385-215-9985
Fax Number	:	877-225-9880

Provider Business Practice Location Address
First Line	:	471 E 1000 S STE D
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3694
Country	:	US
Telephone Number	:	385-215-9985
Fax Number	:	877-225-9880

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID PATTERSON
Credential	:	CO
Telephone Number	:	385-215-9985

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	01/17/2024

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