Individual
MR. MITCHELL TAYLOR PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1050 E SOUTH TEMPLE, SALT LAKE CITY, UT 84102-1507
(801) 350-4111
Mailing address
1050 E SOUTH TEMPLE, SALT LAKE CITY, UT 84102-1507
(801) 350-4111
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8331271-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621795214
—
UT
Enumeration date
04/04/2013
Last updated
04/04/2013
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