Individual
AMANDA KHOURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24 S 1100 E STE 210, SALT LAKE CITY, UT 84102-1580
(801) 505-5277
(801) 505-5280
Mailing address
280 S MAIN ST, BOUNTIFUL, UT 84010-6236
(801) 505-0821
(801) 505-0803
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
12612990-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12612990-0501
—
UT
Enumeration date
05/01/2019
Last updated
05/03/2022
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