Provider Demographics
NPI:1487292439
Name:PORTABLE WALK-IN WHIRLPOOL TUB L.L.C.
Entity type:Organization
Organization Name:PORTABLE WALK-IN WHIRLPOOL TUB L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-8287
Mailing Address - Street 1:5918 S 350 W
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6981
Mailing Address - Country:US
Mailing Address - Phone:801-590-8287
Mailing Address - Fax:
Practice Address - Street 1:5918 S 350 W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6981
Practice Address - Country:US
Practice Address - Phone:801-590-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment