Healthcare Provider Details

I. General information

NPI: 1851378830
Provider Name (Legal Business Name): DREW NORWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 W 10000 S
SOUTH JORDAN UT
84095-4104
US

IV. Provider business mailing address

9720 S 1300 E #W200
SANDY UT
84094-3712
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number329997-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: