Provider Demographics
NPI:1659748952
Name:CANYON FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:CANYON FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-609-4743
Mailing Address - Street 1:83 E 1200 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3710
Mailing Address - Country:US
Mailing Address - Phone:801-609-4743
Mailing Address - Fax:801-804-5545
Practice Address - Street 1:607 KIRBY LN STE D
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1368
Practice Address - Country:US
Practice Address - Phone:801-609-4743
Practice Address - Fax:801-804-5545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANYON FOOT AND ANKLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT93570600501332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1659748952OtherGROUP NPI