Healthcare Provider Details

I. General information

NPI: 1356161970
Provider Name (Legal Business Name): TRENT POULSON PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 W 220 N
CEDAR CITY UT
84720-1310
US

IV. Provider business mailing address

2774 W 220 N
CEDAR CITY UT
84720-1310
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-5619
  • Fax:
Mailing address:
  • Phone: 801-369-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRENTON N POULSON
Title or Position: MANAGING MEMBER/OWNER
Credential: DPT
Phone: 801-369-5619