Organization
PURE PERFORMANCE REHAB
Active
Parent organization
12066486-0162
Organization subpart
Yes
Provider details
NPI number
Legal business name
12066486-0162
Authorized official
AUDREY JEAN MALLON DPT (CO-BUSINESS OWNER)
(541) 490-4450
Entity
Organization
Contact information
Practice address
2295 S 2000 E UNIT C, MILLCREEK, UT 84106-4138
(541) 490-4450
Mailing address
235 E WHITLOCK AVE, SALT LAKE CITY, UT 84115-3224
(541) 490-4450
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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