Healthcare Provider Details

I. General information

NPI: 1295480309
Provider Name (Legal Business Name): GUNNAR RAWLINGS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 W 2200 S
WEST VALLEY CITY UT
84119-1456
US

IV. Provider business mailing address

11856 S BALLOT RD
DRAPER UT
84020-6817
US

V. Phone/Fax

Practice location:
  • Phone: 801-972-8850
  • Fax:
Mailing address:
  • Phone: 801-836-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12697414-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: