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General NPI Number Information
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NPI Number | 1336518760
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Entity Type | Individual
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Provider Name | TYRONE PAMILOZA PT
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 11/29/2015
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Provider Practice Location Address
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Address Line | 1100 S 2000 E APT E239
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City | CLEARFIELD
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State | UT
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Zip | 84015-1485
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Country | US
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Telephone | 385-419-7379
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Fax |
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Provider Business Mailing Address
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Address Line | 2084 N 1700 W
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City | LAYTON
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State | UT
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Zip | 84041-1100
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Country | US
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Telephone | 385-419-7379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 93762922401
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License Number State | UT
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