Provider Demographics
NPI:1912482621
Name:DESERT OAK PHOTOTHERAPY LLC
Entity Type:Organization
Organization Name:DESERT OAK PHOTOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BRINKERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-680-5606
Mailing Address - Street 1:922 E CORRAL WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8249
Mailing Address - Country:US
Mailing Address - Phone:435-632-0375
Mailing Address - Fax:
Practice Address - Street 1:922 E CORRAL WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8249
Practice Address - Country:US
Practice Address - Phone:435-632-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies