Basic Information
| Provider Information | |||||||||
| NPI: | 1679747224 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WASATCH PEAK, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1492 W ANTELOPE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018258091 | ||||||||
| FaxNumber: | 8018258142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1492 W ANTELOPE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018258091 | ||||||||
| FaxNumber: | 8018258142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | SHELDON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8018258091 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 1212642401 | UT | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.