Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 121711-2401 | UT |
NPI | 1114044187 |
---|---|
Provider Name | Dr. Diane E. Nicholson |
First Address | Sandy, UT 84092-7259 |
Second Address | Salt Lake City, UT 84108-1213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |