Healthcare Provider Details

I. General information

NPI: 1407581754
Provider Name (Legal Business Name): MARK GUYMON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE G50
MURRAY UT
84107-6165
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-5000
  • Fax: 801-314-5011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12847031-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: