# OREM SPORTS MEDICINE CENTER, LLC

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

## Provider details

- **NPI number:** 1659397313
- **Authorized official:** MR. MATTHEW F BUSHNELL DPT (OWNER)
- **Authorized official phone:** (801) 830-3034

## Contact information

- **Practice address:** 980 E 800 N STE 103, OREM, UT 84097-4261
- **Practice address phone:** (801) 226-0599
- **Practice address fax:** (801) 226-3145
- **Mailing address:** 524 W 300 N STE 201, PROVO, UT 84601-2669
- **Mailing address phone:** (801) 370-9981
- **Mailing address fax:** (801) 370-9984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4739582-2401 | UT | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 11/27/2023