Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 276912-2401 | UT |
NPI | 1003053596 |
---|---|
Provider Name | Todd Chynoweth |
First Address | Sandy, UT 84094-3632 |
Second Address | Sandy, UT 84094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2009 |
Last Update Date | 21/01/2009 |