Provider Demographics
NPI:1194560888
Name:ODAN LLC
Entity type:Organization
Organization Name:ODAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-458-7707
Mailing Address - Street 1:325 W CENTER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2000
Mailing Address - Country:US
Mailing Address - Phone:385-406-4006
Mailing Address - Fax:801-421-1752
Practice Address - Street 1:325 W CENTER ST STE 204
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2000
Practice Address - Country:US
Practice Address - Phone:385-406-4006
Practice Address - Fax:801-421-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy