MEDICARE: KIMBERLY FJELSTROM DPT

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	5007041-2401	UT

General Provider Information

NPI Number	:	1619539780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FJELSTROM DPT

Provider Business Mailing Address
First Line	:	10959 S TOPVIEW RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-7742
Country	:	US
Telephone Number	:	385-424-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	12403 S DOREEN DR
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-4360
Country	:	US
Telephone Number	:	385-424-2938
Fax Number	:

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	06/28/2019

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