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NPI 1568041325 · Physical Medicine & Rehabilitation Physician · Midvale, UT
Provider details
- NPI number
- 1568041325
- Entity type
- Individual
- Primary specialty
- Physical Medicine & Rehabilitation PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- 35783 (WV)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
7259 S Bingham Junction Blvd
Midvale, UT 84047-4860
Phone: (801) 930-3000
Approximate (ZIP-level) locationGet directions
Mailing address
7259 S Bingham Junction Blvd
Midvale, UT 84047-4860
Registry dates
- Enumerated
- 2021-04-07
- Last updated
- 2025-10-01
- Certified
- 2025-10-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.