| NPI | 1972915874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA J TIDSWELL Manager 801-718-5378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: UT 5080663-2401) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: UT 5080663-4810) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |