Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 6434200-2401 | UT |
NPI | 1043366222 |
---|---|
Provider Name | Miss Jenee Lee Trcka |
First Address | Pleasant Grove, UT 84062-2385 |
Second Address | Lehi, UT 84043-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |