Provider Demographics
NPI:1740884907
Name:REBORN PELVIC HEALTH & WELLNESS
Entity type:Organization
Organization Name:REBORN PELVIC HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-702-8475
Mailing Address - Street 1:10806 S WEISS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7748
Mailing Address - Country:US
Mailing Address - Phone:608-553-2963
Mailing Address - Fax:
Practice Address - Street 1:7611 S JORDAN LANDING BLVD # 130
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5610
Practice Address - Country:US
Practice Address - Phone:801-216-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy