Provider Demographics
NPI:1477315232
Name:HARBOR AMPUTATION REHABILITATION & ADAPTIVE TRAINING
Entity Type:Organization
Organization Name:HARBOR AMPUTATION REHABILITATION & ADAPTIVE TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HELENEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-828-8105
Mailing Address - Street 1:PO BOX 521748
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-1748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 S 700 E STE 2F
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2886
Practice Address - Country:US
Practice Address - Phone:801-828-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee