Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 7987494-2401 | UT |
NPI | 1770919714 |
---|---|
Provider Name | Mr. Bojan Jurosevic |
First Address | Sandy, UT 84094-0744 |
Second Address | Sandy, UT 84094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 04/12/2019 |