Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 348508-2401 | UT |
N | 2081S0010X | Sports Medicine | 348508-2401 | UT |
N | 213ES0000X | Sports Medicine | 348508-2401 | UT |
N | 225100000X | Physical Therapist | 348508-2401 | UT |
NPI | 1518942291 |
---|---|
Provider Name | Mr. John Michael Orr |
First Address | South Jordan, UT 84095 |
Second Address | South Jordan, UT 84095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 19/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U000079308 | (02) | UT |