Individual
MR. AMBROSE JERICHO CUISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 585-2119
Mailing address
PO BOX 564, BOUNTIFUL, UT 84011-0564
(801) 721-1683
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
353978-2401
UT
Other
Enumeration date
09/01/2011
Last updated
12/07/2021
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