MEDICARE: STEVEN M WIXOM PT, DPT, CHT

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	2251H1200X	Hand Physical Therapist	275343-2401	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9402	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	27534324000001	OTHER	UT	BLUE CROSS BLUE SHIELD
3	6400654	OTHER	UT	UNITED HEALTHCARE
4	69156	OTHER	UT	PEHP
5	5417	OTHER	UT	DMBA
6	1108540001	OTHER	UT	CIGNA DMERC
7	870388269BR1	OTHER	UT	EDUCATORS MUTUAL

General Provider Information

NPI Number	:	1093716680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN M WIXOM PT, DPT, CHT

Provider Business Mailing Address
First Line	:	5151 S 900 E
Second Line	:	#100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6657
Country	:	US
Telephone Number	:	801-261-3321
Fax Number	:	801-261-5942

Provider Business Practice Location Address
First Line	:	702 E SOUTH TEMPLE
Second Line	:	#102
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1204
Country	:	US
Telephone Number	:	801-328-8535
Fax Number	:	801-364-1242

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/20/2021

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Directions to “ STEVEN M WIXOM PT, DPT, CHT” Practice Location

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