Individual
TANIA M NICLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3584 W 9000 S, JORDAN VALLEY MEDICAL CENTER PHYSICAL THERAPY SUITE 102, WEST JORDAN, UT 84088-5710
(801) 601-2309
Mailing address
12799 ASPEN SPRINGS DR, RIVERTON, UT 84096-7339
(801) 254-6027
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D6951
—
UT
Enumeration date
11/17/2006
Last updated
10/16/2009
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