Provider Demographics
NPI:1083841597
Name:PERSONAL PERFORMANCE MEDICAL CORPORATION
Entity type:Organization
Organization Name:PERSONAL PERFORMANCE MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PROSTHETIS
Authorized Official - Phone:801-364-3100
Mailing Address - Street 1:7575 S 900 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2343
Mailing Address - Country:US
Mailing Address - Phone:801-364-3100
Mailing Address - Fax:801-872-5714
Practice Address - Street 1:720 S RIVER RD STE B205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5532
Practice Address - Country:US
Practice Address - Phone:435-634-0070
Practice Address - Fax:435-634-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier