Healthcare Provider Details

I. General information

NPI: 1932065190
Provider Name (Legal Business Name): COURTNEY JAE LEWIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY POULSON PT, DPT

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 5600 S
ROY UT
84067-1372
US

IV. Provider business mailing address

2700 W 5600 S
ROY UT
84067-1372
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-9731
  • Fax:
Mailing address:
  • Phone: 801-825-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13972406-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: