MEDICARE: DARREN H AVERETT 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	347054-2401	UT

General Provider Information

NPI Number	:	1548232549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN H AVERETT DPT

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:	ATTN: CREDENTIALING
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	555 WEST SR 164
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653
Country	:	US
Telephone Number	:	385-203-1313
Fax Number	:	801-429-0629

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/24/2023

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Directions to “ DARREN H AVERETT DPT” Practice Location

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