| Organization Name: | PHYSICIAN WOUND CARE AND HYPERBARIC SERVICE LLC |
| NPI Number: | 1245464858 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRET ROBERT BOYLE (MEDICAL DIRECTOR/PROVIDER) |
| Mailing Address: | 6508 Canyon Cove Dr Holladay |
| State: | UT US |
| Postal Code: | 841216339 |
| Phone Number: | 8012720355 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2009 |
| NPI Last Update Date: | 06/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 6780757-1204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |