Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 11868623-8016 | UT |
Y | 225100000X | Physical Therapist | 11868623-2401 | UT |
NPI | 1053922583 |
---|---|
Provider Name | Mitchell Orr |
First Address | Slc, UT 84108-1302 |
Second Address | Slc, UT 84102-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2020 |
Last Update Date | 01/12/2021 |