Healthcare Provider Details

I. General information

NPI: 1114447653
Provider Name (Legal Business Name): NAQUITA AHERN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N 2030 E
SALT LAKE CITY UT
84112-5339
US

IV. Provider business mailing address

15 N 2030 E
SALT LAKE CITY UT
84112-5339
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-8711
  • Fax:
Mailing address:
  • Phone: 801-587-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number8892712-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: