Healthcare Provider Details

I. General information

NPI: 1760031579
Provider Name (Legal Business Name): JONATHAN DAVID PIERCE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 N REDWOOD RD STE 115
SARATOGA SPRINGS UT
84045-5189
US

IV. Provider business mailing address

9844 S 1300 E STE 300
SANDY UT
84094-4693
US

V. Phone/Fax

Practice location:
  • Phone: 801-768-8808
  • Fax:
Mailing address:
  • Phone: 801-571-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number106083-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: