Individual
MARK FRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4785 W 4100 S, WEST VALLEY CITY, UT 84120-4959
(801) 955-0500
Mailing address
4785 W 4100 S, WEST VALLEY CITY, UT 84120-4959
(801) 955-0500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11405580-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11405580-2401
STATE LICENSE
UT
Enumeration date
11/11/2020
Last updated
11/11/2020
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