MEDICARE: DAVID BERT FRANDSEN MSPT

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	4949766-2401	UT

General Provider Information

NPI Number	:	1720091473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BERT FRANDSEN MSPT

Provider Business Mailing Address
First Line	:	PO BOX 837
Second Line	:
City	:	PANGUITCH
State	:	UT
Zip	:	84759-0837
Country	:	US
Telephone Number	:	435-676-2073
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S 250 W
Second Line	:
City	:	PANGUITCH
State	:	UT
Zip	:	84759-0837
Country	:	US
Telephone Number	:	435-676-2073
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID BERT FRANDSEN MSPT” Practice Location

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