Healthcare Provider Details

I. General information

NPI: 1760891006
Provider Name (Legal Business Name): HUSAYN HOWARD OTR/L, PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 E 7000 S
SALT LAKE CITY UT
84121-6877
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171-1185
US

V. Phone/Fax

Practice location:
  • Phone: 801-942-3311
  • Fax: 801-942-5955
Mailing address:
  • Phone: 801-942-3311
  • Fax: 801-942-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3287
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43473
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1258687
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13231
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15-0575
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: