Basic Information
| Provider Information | |||||||||
| NPI: | 1053702985 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SALTZMAN | ||||||||
| FirstName: | JACIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1088 W 1360 S | ||||||||
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| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840582265 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1034 N 500 W | ||||||||
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| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 73536772401 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.