=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861597957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONTE ROD ZUNDEL MS, PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1638 N WASHINGTON BLVD STE 103
-----------------------------------------------------
City | NORTH OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-3790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-782-3500
-----------------------------------------------------
Fax | 801-786-1926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2713 W 1575 N
-----------------------------------------------------
City | PLAIN CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-8535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-782-3500
-----------------------------------------------------
Fax | 801-786-1926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 367930-2401
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------