Individual
MIKE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12391 S 4000 W, #210, RIVERTON, UT 84096-7012
(801) 446-0990
Mailing address
9720 S 1300 E, #W200, SANDY, UT 84094-3712
(801) 230-2376
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9255052-2401
UT
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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