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NPI Code Detail

MEDICARE: MR. ANTHONY JEROME CHRISTOPHE THERAPIST

MEDICARE: MR. ANTHONY JEROME CHRISTOPHE THERAPIST
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
11041C0700XClinical Social Worker10836743-3502UT

General Provider Information

NPI Number : 1619297827
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY JEROME CHRISTOPHE THERAPIST
Provider Business Mailing Address
First Line : 68 S 600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1007
Country : US
Telephone Number : 801-322-1001
Fax Number :
Provider Business Practice Location Address
First Line : 2450 E FT UNION BLVD
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3337
Country : US
Telephone Number : 801-428-3402
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2010
Last Update Date : 02/02/2022

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