MEDICARE: MR. MARK JAMES CHRISTENSON PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	364957-2401	UT

General Provider Information

NPI Number	:	1043366230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JAMES CHRISTENSON PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1591 S 1400 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2642
Country	:	US
Telephone Number	:	801-824-4764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1591 S 1400 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2642
Country	:	US
Telephone Number	:	801-824-4764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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