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Individual
MARK LAVON JORGENSEN
Active
Individual
MARK LAVON JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
269867-2401
UT
Other
Enumeration date
06/20/2012
Last updated
05/15/2015
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