Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 13320 | AZ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9058233-2401 | UT |
NPI | 1013315712 |
---|---|
Provider Name | Jonathon Oliver Eichner |
First Address | American Fork, UT 84003-2151 |
Second Address | Scottsdale, AZ 85258-4556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2014 |
Last Update Date | 22/09/2021 |