MEDICARE: DOUGLAS FRANCIS BARDUGON 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	225100000X	Physical Therapist	283387-2401	UT

General Provider Information

NPI Number	:	1922180942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS FRANCIS BARDUGON PT

Provider Business Mailing Address
First Line	:	PO BOX 27247
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0247
Country	:	US
Telephone Number	:	801-269-2696
Fax Number	:	801-269-2690

Provider Business Practice Location Address
First Line	:	5662 COUGAR LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-6055
Country	:	US
Telephone Number	:	801-269-2696
Fax Number	:	801-269-2690

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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