Healthcare Provider Details

I. General information

NPI: 1184552648
Provider Name (Legal Business Name): EMMA GABRIELLE NIEVES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 E 800 N STE 103
OREM UT
84097-4261
US

IV. Provider business mailing address

5989 WESTRIDGE RD
HEBER CITY UT
84032-5685
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-0599
  • Fax:
Mailing address:
  • Phone: 443-632-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14286659-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: