Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3088002401 | UT |
NPI | 1053640128 |
---|---|
Provider Name | Kerry L Groebs |
First Address | Murray, UT 84107-6121 |
Second Address | Murray, UT 84107-6121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2009 |
Last Update Date | 18/12/2009 |