Healthcare Provider Details

I. General information

NPI: 1205347010
Provider Name (Legal Business Name): DR. JENNIFER DELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 03/16/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E WADSWORTH PARK DR STE 230
DRAPER UT
84020-8096
US

IV. Provider business mailing address

273 12TH ST NE UNIT 114
ATLANTA GA
30309-5013
US

V. Phone/Fax

Practice location:
  • Phone: 385-308-8034
  • Fax:
Mailing address:
  • Phone: 336-314-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number180405
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37759
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15713-24
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28694
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH10598
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048408
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013601
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6015
License Number StateNM
# 10
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7945
License Number StateID
# 11
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2141
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: