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Organization
EPIC PROSTHETICS AND ORTHOTICS LLC
Active
Organization
EPIC PROSTHETICS AND ORTHOTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE COBURN DAVIS CPO, MSPO (OWNER/CLINICAL MANAGER)
(801) 820-0045
Entity
Organization
Contact information
Practice address
635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
(801) 820-0087
(801) 820-2852
Mailing address
635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
(801) 820-0087
(801) 820-2852
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
NULL
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
—
NULL
224P00000X
Prosthetist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
NULL
Other
Enumeration date
02/07/2022
Last updated
12/09/2022
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