Provider Demographics
NPI:1962529008
Name:QUANTUM INJURY AND PAIN CLINIC LLC
Entity type:Organization
Organization Name:QUANTUM INJURY AND PAIN CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-651-9263
Mailing Address - Street 1:9601 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3661
Mailing Address - Country:US
Mailing Address - Phone:801-651-9263
Mailing Address - Fax:
Practice Address - Street 1:870 E 9400 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3666
Practice Address - Country:US
Practice Address - Phone:801-553-9966
Practice Address - Fax:801-553-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT213662-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty