Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 110922452401 | UT |
NPI | 1053977769 |
---|---|
Provider Name | Michael Tobler |
First Address | Sandy, UT 84094-4693 |
Second Address | Salt Lake City, UT 84121-6926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2019 |
Last Update Date | 17/05/2019 |