Healthcare Provider Details

I. General information

NPI: 1396041034
Provider Name (Legal Business Name): TIFFANY SCHOENBERGER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7000
  • Fax:
Mailing address:
  • Phone: 801-507-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number55720932402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: