1831609486 NPI number — MISS RACHEL LAUREN GENTHER LAT, ATC

Table of content: MISS RACHEL LAUREN GENTHER LAT, ATC (NPI 1831609486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831609486 NPI number — MISS RACHEL LAUREN GENTHER LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENTHER
Provider First Name:
RACHEL
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831609486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 EAST 300 SOUTH #810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-890-9738
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 SOUTH 150 EAST SUITE 460
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-748-1861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  9705668-4810 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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