Healthcare Provider Details

I. General information

NPI: 1649166208
Provider Name (Legal Business Name): SADIE JIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6069 S HIGHLAND DR
HOLLADAY UT
84121-1375
US

IV. Provider business mailing address

6069 S HIGHLAND DR
HOLLADAY UT
84121-1375
US

V. Phone/Fax

Practice location:
  • Phone: 801-944-1209
  • Fax:
Mailing address:
  • Phone: 917-575-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number142243312401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: