The Sports Med Spa LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

THE SPORTS MED SPA LLC

Practice address

3580 W 9000 S
West Jordan, UT 84088-8812

Phone

(801) 448-2218

NPI assigned

Sep 8, 2025

Organization subpart

No

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

Authorized official

Name

Gibran BorjaNPI 1679125934

Title

Owner

Phone

(801) 448-2218

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gibran Borja

  • Physician Assistant
  • West Jordan, UT
  • NPI 1679125934
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1679453781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 W S JORDAN PKWY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840095761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 W 9000 S",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888812",
            "telephone_number": "801-448-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPORTS MED SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "BORJA",
        "authorized_official_first_name": "GIBRAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-448-2218"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael C Tew, D.D.S.
• Roxanne V Thacker, PHARM. D.
• The Legacy Foundations
• The Next Right Thing in Recovery
• The Next Right Thing in Recovery
• Satia Theroux
• Vilayvone Thipsouvan
• Erica Thoen, LCSW
• Thomas S Cannon MD
• Thomas S Cannon MD PLLC

• Physician Assistant in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.