Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 292357-2401 | UT |
NPI | 1326541145 |
---|---|
Provider Name | Mr. Robert Chynoweth |
First Address | Salt Lake City, UT 84124-1349 |
Second Address | Salt Lake City, UT 84124-1349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2018 |
Last Update Date | 18/03/2018 |