MEDICARE: IPTI HOME HEALTH AGENCY, 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	251E00000X	Home Health Agency	2017HHAUT000792	UT

General Provider Information

NPI Number	:	1932646221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IPTI HOME HEALTH AGENCY, LLC

Provider Business Mailing Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0258
Fax Number	:

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0258
Fax Number	:

Authorized Official
Title or Position	:	MANAGER AND MEMBER
Name	:	MURIEL J LEE
Credential	:	PT
Telephone Number	:	801-251-0258

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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