MEDICARE: MR. JOHN W. FEIG RPT

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	92-1216002401	UT

General Provider Information

NPI Number	:	1245243864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN W. FEIG RPT

Provider Business Mailing Address
First Line	:	PO BOX 71403
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-0403
Country	:	US
Telephone Number	:	801-944-1209
Fax Number	:	801-944-8994

Provider Business Practice Location Address
First Line	:	7350 WASATCH BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-4627
Country	:	US
Telephone Number	:	801-944-1209
Fax Number	:	801-944-8994

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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