Healthcare Provider Details

I. General information

NPI: 1144706466
Provider Name (Legal Business Name): MATTHEW JERRY HOBBS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S STE 200
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-676-2210
  • Fax: 801-676-2212
Mailing address:
  • Phone: 801-572-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10915311-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: