Organization
SUNSHINE TERRANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BROCK KEITH CHRISTENSEN OTR/L (OCCUPATIONAL THERAPIST)
(435) 512-9071
Entity
Organization
Contact information
Practice address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8535
Mailing address
1277 E 100 S, LOGAN, UT 84321-4974
(435) 512-9071
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
92879094201
UT
261QM1300X
Multi-Specialty Clinic/Center
92879094201
UT
261QR0400X
Rehabilitation Clinic/Center
Primary
92879094201
UT
314000000X
Skilled Nursing Facility
92879094201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9287909-4201
—
UT
05
—
92879094201
—
UT
Enumeration date
02/02/2015
Last updated
02/02/2015
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