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General NPI Number Information
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NPI Number | 1538188479
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Entity Type | Individual
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Provider Name | NORDELL E PETERSON P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1425 S 1500 E
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City | CLEARFIELD
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State | UT
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Zip | 84015-1621
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Country | US
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Telephone | 801-779-0798
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Fax | 801-779-2798
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Provider Business Mailing Address
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Address Line | 1450 SOUTH 1500 EAST
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City | CLEARFIELD
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State | UT
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Zip | 84015-1633
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Country | US
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Telephone | 801-397-4340
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Fax | 801-397-4390
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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 | 1101962401
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License Number State | UT
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