Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5287498-2401 | UT |
NPI | 1407053614 |
---|---|
Provider Name | Monica Ann Frederick |
First Address | Slc, UT 84151-0721 |
Second Address | Slc, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 07/12/2021 |