Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 8334630-2402 | UT |
NPI | 1013409093 |
---|---|
Provider Name | Jon Gabriel Osorio |
First Address | Sunset, UT 84015-3416 |
Second Address | Ogden, UT 84408-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2018 |
Last Update Date | 05/06/2018 |