Organization
UTAH SPORTS AND ORTHOPEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MANGUM DO (CEO)
(801) 410-0205
Entity
Organization
Contact information
Practice address
2516 E SNOW MOUNTAIN DR, SANDY, UT 84093-1858
(801) 410-0205
Mailing address
2516 E SNOW MOUNTAIN DR, SANDY, UT 84093-1858
Taxonomy
Speciality
Code
Description
License number
State
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
2080S0010X
Pediatric Sports Medicine Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
—
2251S0007X
Sports Physical Therapist
—
—
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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