Basic Information
| Provider Information | |||||||||
| NPI: | 1952551939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENROD | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 W 600 N | ||||||||
| Address2: | |||||||||
| City: | TREMONTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843372400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352574400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 460 W 600 N | ||||||||
| Address2: | |||||||||
| City: | TREMONTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843372400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352574400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2008 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1197642401 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-2169 | ID | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.