Organization
UTAH WEIGHT LOSS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED RASMUSSEN (ADMINISTRATOR)
(801) 374-9625
Entity
Organization
Contact information
Practice address
1055 N 300 W STE 302, PROVO, UT 84604-3373
(801) 852-3468
(801) 852-3459
Mailing address
3550 N UNIVERSITY AVE STE 250, PROVO, UT 84604-6685
(801) 374-9625
(801) 374-9690
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
283029-1205
UT
Other
Enumeration date
02/18/2016
Last updated
02/18/2016
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