Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-5333 | ID |
NPI | 1003218512 |
---|---|
Provider Name | Zebadia Pessetto |
First Address | Salt Lake City, UT 84130-0180 |
Second Address | Heber City, UT 84032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2014 |
Last Update Date | 23/10/2019 |