Healthcare Provider Details

I. General information

NPI: 1518627579
Provider Name (Legal Business Name): CINDY ANDREA ESQUIVEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S 4000 W STE 340
WEST VALLEY CITY UT
84120-3287
US

IV. Provider business mailing address

PO BOX 70689
SALT LAKE CITY UT
84170-0689
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-5017
  • Fax:
Mailing address:
  • Phone: 801-987-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number12127461-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: