Individual
MONT DIDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
551 S 455 E, SMITHFIELD, UT 84335-1355
(435) 757-4847
Mailing address
551 S 455 E, SMITHFIELD, UT 84335-1355
(435) 757-4847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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