Organization
TIMBER RIDGE HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN PENNOCKS DTP (MEDICAL DIRECTOR)
(801) 698-1160
Entity
Organization
Contact information
Practice address
448 E 5350 S STE B, WASHINGTON TERRACE, UT 84405-5415
(801) 540-4564
Mailing address
448 E 5350 S STE B, WASHINGTON TERRACE, UT 84405-5415
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
Other
Enumeration date
08/18/2009
Last updated
08/18/2009
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