Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6500354-2401 | UT |
NPI | 1063839736 |
---|---|
Provider Name | Coleby Clawson |
First Address | Springville, UT 84663-2027 |
Second Address | Springville, UT 84663-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 19/03/2014 |