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Organization
CUSTOM SPECIALTY REHAB
Active
Organization
CUSTOM SPECIALTY REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT CHRISTIAN PAULSEN (OWNER)
(801) 781-0084
Entity
Organization
Contact information
Practice address
5820 W 3800 S, HOOPER, UT 84315-9803
(801) 781-0084
Mailing address
5820 W 3800 S, HOOPER, UT 84315-9803
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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