Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 290655-2401 | UT |
NPI | 1245351899 |
---|---|
Provider Name | Jason T Terry |
First Address | Salt Lake City, UT 84143-0001 |
Second Address | Salt Lake City, UT 84143-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |