MEDICARE: MR. ROBERT CHYNOWETH 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
1	2251G0304X	Geriatric Physical Therapist	292357-2401	UT

General Provider Information

NPI Number	:	1326541145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CHYNOWETH PT

Provider Business Mailing Address
First Line	:	1250 E 3900 S STE 440
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1349
Country	:	US
Telephone Number	:	801-400-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 440
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1349
Country	:	US
Telephone Number	:	801-400-2052
Fax Number	:

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

Provider Enumeration Date	:	03/18/2018
Last Update Date	:	03/18/2018

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