Individual
MISCHA WAYAN-LEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1512 S NATURA ST, SALT LAKE CITY, UT 84104-2172
(360) 820-1015
Mailing address
1512 S NATURA ST, SALT LAKE CITY, UT 84104-2172
(360) 820-1015
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8603819-2402
UT
Other
Enumeration date
11/11/2016
Last updated
09/09/2022
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