Healthcare Provider Details

I. General information

NPI: 1760464887
Provider Name (Legal Business Name): PAUL DURANT STONEMAN PT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/27/2023
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WEST SR 164
SALEM UT
84653
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604-7324
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-1313
  • Fax: 801-429-0629
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number50808
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number50808
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: