Individual
STEVEN M WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CHT
Contact information
Practice address
702 E SOUTH TEMPLE, #102, SALT LAKE CITY, UT 84102-1204
(801) 328-8535
(801) 364-1242
Mailing address
5151 S 900 E, #100, SALT LAKE CITY, UT 84117-6657
(801) 261-3321
(801) 261-5942
Taxonomy
Speciality
Code
Description
License number
State
2251H1200X
Hand Physical Therapist
Primary
275343-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108540001
CIGNA DMERC
UT
01
—
27534324000001
BLUE CROSS BLUE SHIELD
UT
01
—
5417
DMBA
UT
01
—
6400654
UNITED HEALTHCARE
UT
01
—
69156
PEHP
UT
01
—
870388269BR1
EDUCATORS MUTUAL
UT
01
—
CJ9402
RAILROAD MEDICARE
UT
Enumeration date
08/03/2005
Last updated
12/20/2021
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