Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 12201338-2401 | UT |
NPI | 1356917090 |
---|---|
Provider Name | Mr. Wesley Santillan Spargo |
First Address | Murray, UT 84107-3231 |
Second Address | Murray, UT 84107-3231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |