Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 275437-2401 | UT |
NPI | 1639228927 |
---|---|
Provider Name | Dr. Robert Willard Shingleton |
First Address | Cottonwood Heights, UT 84121-2963 |
Second Address | Cottonwood Heights, UT 84121-2963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U000074461 | PTAN (01) | UT |