| Metrodora Clinic, Pllc | |
|
3535 S Market St Ste 800 West Valley City UT 84119-3617 | |
| (801) 907-1796 | |
| Not Available |
| Full Name | Metrodora Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3535 S Market St Ste 800, West Valley City, Utah |
| Authorized Official Name and Position | Laura A. Pace (CEO) |
| Authorized Official Contact | 3854301431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Metrodora Clinic, Pllc 3535 S Market St # 175 West Valley City UT 84119-3617 Ph: (203) 858-8679 | Metrodora Clinic, Pllc 3535 S Market St Ste 800 West Valley City UT 84119-3617 Ph: (801) 907-1796 |
| NPI Number | 1124762281 |
|---|---|
| Provider Enumeration Date | 04/25/2022 |
| Last Update Date | 01/07/2023 |
| Certification Date | 01/07/2023 |
| Medicare PECOS PAC ID | 8628430766 |
|---|---|
| Medicare Enrollment ID | O20230822000226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124762281 | NPI | - | NPPES |
| Provider Name | Joseph H Berman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780772624 PECOS PAC ID: 6901855923 Enrollment ID: I20050118000235 |
| Provider Name | Kasey D Mitchell |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073827572 PECOS PAC ID: 1951582691 Enrollment ID: I20110301000091 |
| Provider Name | Sarah Gallant |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1902154214 PECOS PAC ID: 3274755525 Enrollment ID: I20141120002645 |
| Provider Name | Alexandra Cayias |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1336415520 PECOS PAC ID: 2466770524 Enrollment ID: I20150421002297 |
| Provider Name | Ryan Pelo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497045777 PECOS PAC ID: 2860708609 Enrollment ID: I20150825003840 |
| Provider Name | Laura Pace |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1104142025 PECOS PAC ID: 3678868262 Enrollment ID: I20160822001326 |
| Provider Name | Kathryn Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891079208 PECOS PAC ID: 3274829072 Enrollment ID: I20160902001042 |
| Provider Name | Thomas Cayias |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326497793 PECOS PAC ID: 1153617410 Enrollment ID: I20160913000869 |
| Provider Name | Benjamin Ostler |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326595653 PECOS PAC ID: 8426336306 Enrollment ID: I20161027001110 |
| Provider Name | Brittany Sue Jorgensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932685500 PECOS PAC ID: 5799039400 Enrollment ID: I20181116000031 |
| Provider Name | Kelsi Midori-joan Schiltz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043626542 PECOS PAC ID: 4183841463 Enrollment ID: I20190326002870 |
| Provider Name | Glen Cook |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740418045 PECOS PAC ID: 2466605019 Enrollment ID: I20230907003924 |
| Provider Name | Nada Hindiyeh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831320720 PECOS PAC ID: 6608092440 Enrollment ID: I20230912000673 |
| Provider Name | John Erikson Yap |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184912529 PECOS PAC ID: 3678896412 Enrollment ID: I20230912000826 |
| Provider Name | Amy Pham |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1164130258 PECOS PAC ID: 1658728985 Enrollment ID: I20231108002422 |
| Provider Name | Anne Maitland |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1083660047 PECOS PAC ID: 1658465166 Enrollment ID: I20240212003821 |
| Provider Name | Stacy Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407441942 PECOS PAC ID: 7911303581 Enrollment ID: I20240221002129 |
| Provider Name | Natalie Surut |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922745348 PECOS PAC ID: 7719322643 Enrollment ID: I20240229003605 |
| Provider Name | Emily M Tingey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558134122 PECOS PAC ID: 6406291210 Enrollment ID: I20240304000862 |
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