Provider Demographics
NPI:1053175976
Name:WASATCH RPM LLC
Entity type:Organization
Organization Name:WASATCH RPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FYANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-475-5254
Mailing Address - Street 1:5825 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4316
Mailing Address - Country:US
Mailing Address - Phone:801-475-5254
Mailing Address - Fax:801-797-0278
Practice Address - Street 1:5825 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4316
Practice Address - Country:US
Practice Address - Phone:801-475-5254
Practice Address - Fax:801-797-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty