Healthcare Provider Details

I. General information

NPI: 1669464939
Provider Name (Legal Business Name): JEFFREY N OHLWILER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 E 100 N
PRICE UT
84501-2640
US

IV. Provider business mailing address

PO BOX 933
PRICE UT
84501-0933
US

V. Phone/Fax

Practice location:
  • Phone: 435-613-1500
  • Fax: 435-613-1501
Mailing address:
  • Phone: 435-613-1500
  • Fax: 435-613-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number340535-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: