IndividualActive
Connan Wallace, PT, DPT
NPI 1548019730 · Physical Therapist · Vineyard, UT
Provider details
- NPI number
- 1548019730
- Entity type
- Individual
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PT, DPT
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
691 E 400 N Ste 210
Vineyard, UT 84059-7510
Phone: (801) 766-4244
Approximate (ZIP-level) locationGet directions
Mailing address
4087 W Great Neck Dr
South Jordan, UT 84009-6021
Registry dates
- Enumerated
- 2024-05-18
- Last updated
- 2024-05-18
- Certified
- 2024-05-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.