MEDICARE: IRENE ACEVEDO PT, CERT MDT, C/NDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5804957-2401	UT

General Provider Information

NPI Number	:	1437254695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE ACEVEDO PT, CERT MDT, C/NDT

Provider Business Mailing Address
First Line	:	3501 LOREN VON DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3816
Country	:	US
Telephone Number	:	801-979-4722
Fax Number	:	801-266-0421

Provider Business Practice Location Address
First Line	:	4885 S 900 E
Second Line	:	STE 110 B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5746
Country	:	US
Telephone Number	:	801-200-3356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/13/2020

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Directions to “ IRENE ACEVEDO PT, CERT MDT, C/NDT” Practice Location

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