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General NPI Number Information
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NPI Number | 1417862194
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Entity Type | Individual
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Provider Name | JACOB RYAN HAMBLIN
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Gender | Male
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 1122 CENTER DR STE D350
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City | PARK CITY
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State | UT
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Zip | 84098-6908
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Country | US
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Telephone | 435-383-2026
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Fax | 435-994-3377
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Provider Business Mailing Address
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Address Line | 657 E ANNASTON PL APT 1
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City | MURRAY
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State | UT
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Zip | 84107-5460
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Country | US
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Telephone | 720-278-0339
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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 | 14287862-2401
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License Number State | UT
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