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NPI Code Detail

MEDICARE: JAMES M WORTLEY PT

MEDICARE: JAMES M WORTLEY PT
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
1225100000XPhysical Therapist117406-2401UT

General Provider Information

NPI Number : 1326031493
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES M WORTLEY PT
Provider Business Mailing Address
First Line : PO BOX 307
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84011-0307
Country : US
Telephone Number : 888-700-6907
Fax Number : 801-294-6917
Provider Business Practice Location Address
First Line : 441 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84104-3539
Country : US
Telephone Number : 801-975-1403
Fax Number : 801-975-1403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 12/13/2007

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