Individual
MICAELA JARAMILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1430 E 4500 S, SALT LAKE CITY, UT 84117-4208
(801) 671-2787
(801) 671-2787
Mailing address
1352 E ROYAL TROON DR APT 10, SALT LAKE CITY, UT 84124-4125
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9779273-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221417462
DRIVERS LICENSE
UT
01
—
9779273-2401
DIVISION OF OCCUPATION AND PROFESSIONAL LICENSING
UT
Enumeration date
12/18/2017
Last updated
12/18/2017
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