Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7659678-2401 | UT |
NPI | 1003135880 |
---|---|
Provider Name | Eon Jarvis |
First Address | Salt Lake City, UT 84171-1185 |
Second Address | Salt Lake City, UT 84121-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 20/12/2021 |