# PERFORMANCE GOLF & WELLNESS CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093731754
- **Authorized official:** MR. HENRY WHITE M.P.T (OWNER)
- **Authorized official phone:** (801) 746-8997

## Contact information

- **Practice address:** 1285 GUNN AVE, SALT LAKE CITY, UT 84106-3039
- **Practice address phone:** (801) 746-8997
- **Practice address fax:** (801) 746-8996
- **Mailing address:** PO BOX 307, BOUNTIFUL, UT 84011-0307
- **Mailing address phone:** (888) 700-6907
- **Mailing address fax:** (801) 294-6917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 325159-2401 | UT | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 08/22/2020