MEDICARE: GEORGE A SHIRLEY

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	6006997-2401	UT

General Provider Information

NPI Number	:	1942287040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE A SHIRLEY

Provider Business Mailing Address
First Line	:	9720 S 1300 E
Second Line	:	#W200
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-572-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	9720 S 1300 E
Second Line	:	#W200
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-572-0690
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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Directions to “ GEORGE A SHIRLEY ” Practice Location

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