Individual
KEITH THOMAS PETAGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
443 S 600 E, SALT LAKE CITY, UT 84102-2708
(801) 536-6523
Mailing address
4460 S HIGHLAND DR STE 120, SALT LAKE CITY, UT 84124-3550
(888) 949-4864
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
F24-112623
UT
172V00000X
Community Health Worker
—
—
Other
Enumeration date
06/07/2023
Last updated
10/17/2024
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