Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 10889462-2401 | UT |
NPI | 1053890863 |
---|---|
Provider Name | Rebecca Flegal |
First Address | Midvale, UT 84047-5755 |
Second Address | Midvale, UT 84047-5755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |