| Between The Lines Rejuvenation Llc | |
|
1785 E Wilson Ave Salt Lake City UT 84108-2916 | |
| (877) 258-6331 | |
| (718) 362-1651 |
| Full Name | Between The Lines Rejuvenation Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1785 E Wilson Ave, Salt Lake City, Utah |
| Authorized Official Name and Position | Krista Corbett (OWNER) |
| Authorized Official Contact | 8016941197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Between The Lines Rejuvenation Llc 612 Corporate Way Ste 2m Valley Cottage NY 10989-2027 Ph: (718) 362-1411 | Between The Lines Rejuvenation Llc 1785 E Wilson Ave Salt Lake City UT 84108-2916 Ph: (877) 258-6331 |
| NPI Number | 1396507984 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 07/17/2024 |
| Medicare PECOS PAC ID | 2668817495 |
|---|---|
| Medicare Enrollment ID | O20240301003177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396507984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
| Provider Name | Krista Corbett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326448838 PECOS PAC ID: 3173744174 Enrollment ID: I20240301003075 |
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