Provider Demographics
NPI:1992310593
Name:JUST THE RIGHT AGE
Entity type:Organization
Organization Name:JUST THE RIGHT AGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASTIE
Authorized Official - Suffix:
Authorized Official - Credentials:BC-FNP
Authorized Official - Phone:801-564-7091
Mailing Address - Street 1:7535 S UNION PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3043
Mailing Address - Country:US
Mailing Address - Phone:801-564-7091
Mailing Address - Fax:877-595-1086
Practice Address - Street 1:7535 S UNION PARK AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3043
Practice Address - Country:US
Practice Address - Phone:801-564-7091
Practice Address - Fax:877-595-1086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUST THE RIGHT CURVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT204722-4405OtherUTAH DEPARTMENT OF PROFESSIONAL LICENSING