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General NPI Number Information
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NPI Number | 1568960037
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Entity Type | Organization
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Legal Business Name | NORTHERN HOLDINGS
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 6321 S REDWOOD RD STE 100
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-6799
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Country | US
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Telephone | 801-281-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 6321 S REDWOOD RD STE 107
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-6799
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPT/CONSULTANT
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Name | JACOB EREKSON
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Credential | DPT
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Telephone | 801-281-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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