MEDICARE: MITCHELL GRANT HILL DPT

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	14223239-2401	UT

General Provider Information

NPI Number	:	1124910625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL GRANT HILL DPT

Provider Business Mailing Address
First Line	:	2310 N 400 E STE B
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1799
Country	:	US
Telephone Number	:	435-774-8557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 N 400 E STE B
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1799
Country	:	US
Telephone Number	:	435-774-8557
Fax Number	:

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

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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