Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 000000000000000 | UT |
NPI | 1770762742 |
---|---|
Provider Name | Mr. Jonathon Ben Scheffres |
First Address | Salt Lake City, UT 84102-2161 |
Second Address | Salt Lake City, UT 84106-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 26/10/2007 |