MEDICARE: MICHAEL NAANES

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	9822525-2401	UT

General Provider Information

NPI Number	:	1710436316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NAANES

Provider Business Mailing Address
First Line	:	370 E SOUTH TEMPLE
Second Line	:	SUITE 250
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1206
Country	:	US
Telephone Number	:	801-512-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 EAST 6900 SOUTH
Second Line	:	SUITE 100
City	:	MIDVALE
State	:	UT
Zip	:	84047
Country	:	US
Telephone Number	:	801-890-6626
Fax Number	:

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

Provider Enumeration Date	:	09/25/2016
Last Update Date	:	10/18/2016

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Directions to “ MICHAEL NAANES ” Practice Location

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