Avant-Garde LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

AVANT-GARDE LLC

Doing business as

Minus 250 Degrees Cryotherapy

Practice address

293 E 930 S
Orem, UT 84058-5001

Phone

(801) 548-3417

NPI assigned

Nov 7, 2017

Last updated

Nov 7, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brock Larson Roberts

Title

Managing Director

Phone

(801) 548-3417

Specialties & licenses 2

Addresses

Other names 1

• Minus 250 Degrees Cryotherapy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1164935664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 E 930 S",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840585001",
            "telephone_number": "801-548-3417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 E 930 S",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840585001",
            "telephone_number": "801-548-3417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANT-GARDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "LARSON",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "801-548-3417"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minus 250 Degrees Cryotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Orem, UT
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.