Individual
ETHAN SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9844 S 1300 E STE 200, SANDY, UT 84094-4689
(801) 571-0099
Mailing address
9844 S 1300 E STE 300, SANDY, UT 84094-4693
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8233885-2401
UT
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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