Individual
DR. EVAN MICHAEL PUCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
50 N MEDICAL DR, 1R 5 SOM, SALT LAKE CITY, UT 84132-0001
(801) 585-5323
Mailing address
127 S 500 E, SUITE 600, SALT LAKE CITY, UT 84102-1959
(801) 587-6336
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
9083705-2401
UT
Other
Enumeration date
12/15/2014
Last updated
09/22/2015
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