Healthcare Provider Details

I. General information

NPI: 1578482998
Provider Name (Legal Business Name): MICHAEL DURBANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 W 13400 S
RIVERTON UT
84096-5640
US

IV. Provider business mailing address

5541 W 13400 S
RIVERTON UT
84096-5640
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14292154-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: