Healthcare Provider Details

I. General information

NPI: 1225836588
Provider Name (Legal Business Name): JEFFREY NIELSEN II DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 S 5400 W
MALAD CITY ID
83252-6556
US

IV. Provider business mailing address

45 N 2ND E
PRESTON ID
83263-1334
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-0127
  • Fax:
Mailing address:
  • Phone: 801-935-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8136
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: