Healthcare Provider Details

I. General information

NPI: 1043144637
Provider Name (Legal Business Name): JORDYN FOWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 W 5600 S
ROY UT
84067-8128
US

IV. Provider business mailing address

4246 W 5600 S
ROY UT
84067-8128
US

V. Phone/Fax

Practice location:
  • Phone: 801-395-4618
  • Fax:
Mailing address:
  • Phone: 801-395-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14286653-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: