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General NPI Number Information
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NPI Number | 1215398615
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Entity Type | Organization
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Legal Business Name | REDWOOD INJURY TREATMENT CENTER
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 6321 S REDWOOD RD SUITE 105
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-6798
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Country | US
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Telephone | 801-904-3089
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Fax | 801-904-3435
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Provider Business Mailing Address
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Address Line | 6321 S REDWOOD RD SUITE 105
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-6798
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Country | US
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Telephone | 801-904-3089
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Fax | 801-904-3435
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CLINIC DIRECTOR
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Name | DR. JACOB DANIEL EREKSON
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Credential | DPT
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Telephone | 801-904-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 7376354-2401
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License Number State | UT
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