MEDICARE: HOWARD A KNUDSEN PT PC

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	261QP2000X	Physical Therapy Clinic/Center	51663182401	UT

General Provider Information

NPI Number	:	1881752830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD A KNUDSEN PT PC

Provider Business Mailing Address
First Line	:	3585 N UNIVERSITY AVE
Second Line	:	SUITE100
City	:	PROVO
State	:	UT
Zip	:	84604-6601
Country	:	US
Telephone Number	:	801-310-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 N UNIVERSITY AVE
Second Line	:	SUITE100
City	:	PROVO
State	:	UT
Zip	:	84604-6601
Country	:	US
Telephone Number	:	801-310-0851
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD KNUDSEN
Credential	:	P.T.
Telephone Number	:	801-310-0851

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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