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MONT DIDERICKSEN PT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1063963825

Individual Registrant:
 MONT  DIDERICKSEN PT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
551 S 455 E  SMITHFIELD, UT 84335-1355 US
Tel: 435-757-4847  Fax: --

Contact information for business:
551 S 455 E  SMITHFIELD, UT 84335-1355 US
Tel: 435-757-4847  Fax: --

Registration Information:
NPI: 1063963825
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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