Healthcare Provider Details

I. General information

NPI: 1790330454
Provider Name (Legal Business Name): MICHAEL REY CHRISTENSEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 01/14/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

IV. Provider business mailing address

2363 E NEWCASTLE DR
SANDY UT
84093-1735
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax:
Mailing address:
  • Phone: 801-558-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11363234-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11363234
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: