Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | UT |
NPI | 1225789944 |
---|---|
Provider Name | Kyle Johnson |
First Address | American Fork, UT 84003-2096 |
Second Address | American Fork, UT 84003-2096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2022 |
Last Update Date | 13/01/2022 |