Healthcare Provider Details

I. General information

NPI: 1881752830
Provider Name (Legal Business Name): HOWARD A KNUDSEN PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 N UNIVERSITY AVE SUITE100
PROVO UT
84604-6601
US

IV. Provider business mailing address

3585 N UNIVERSITY AVE SUITE100
PROVO UT
84604-6601
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-0851
  • Fax:
Mailing address:
  • Phone: 801-310-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number51663182401
License Number StateUT

VIII. Authorized Official

Name: HOWARD KNUDSEN
Title or Position: PRESIDENT
Credential: P.T.
Phone: 801-310-0851