Healthcare Provider Details

I. General information

NPI: 1336078567
Provider Name (Legal Business Name): GAGE MANZIONE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 E HIGHWAY 138 STE 400
STANSBURY PARK UT
84074-4028
US

IV. Provider business mailing address

576 E HIGHWAY 138 STE 400
STANSBURY PARK UT
84074-4028
US

V. Phone/Fax

Practice location:
  • Phone: 435-833-9070
  • Fax: 435-243-7375
Mailing address:
  • Phone: 435-833-9070
  • Fax: 435-243-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14286812-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: