Individual
MARK LAVON JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., P.T.
Contact information
Practice address
345 E 9500 S, PARADISE, UT 84328-8903
(435) 764-0710
Mailing address
345 E 9500 S, PARADISE, UT 84328-8903
(435) 764-0710
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
269867-2401
UT
Other
Enumeration date
06/20/2012
Last updated
05/15/2015
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