Provider Demographics
NPI:1659105286
Name:SALT LAKE TENNIS AND HEALTH CLUB
Entity type:Organization
Organization Name:SALT LAKE TENNIS AND HEALTH CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-479-7355
Mailing Address - Street 1:2471 S 1700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3632
Mailing Address - Country:US
Mailing Address - Phone:801-487-3206
Mailing Address - Fax:
Practice Address - Street 1:2471 S 1700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3632
Practice Address - Country:US
Practice Address - Phone:801-487-3206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty