Individual
DEREK IVAN THUESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-2299
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7525850-2401
UT
Other
Enumeration date
02/23/2010
Last updated
02/23/2010
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