Healthcare Provider Details

I. General information

NPI: 1326196668
Provider Name (Legal Business Name): DONATA TRUSSELL-VIAZZO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9361 S 300 E
SANDY UT
84070-2902
US

IV. Provider business mailing address

6517 S SAWTOOTH CIR
TAYLORSVILLE UT
84129-6821
US

V. Phone/Fax

Practice location:
  • Phone: 801-826-5000
  • Fax: 801-826-7209
Mailing address:
  • Phone: 801-915-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number272664-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number272664-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: