Individual
THERESA A HOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
44 MEDICAL DRIVE, SALT LAKE, UT 84113
(801) 584-8521
Mailing address
3020 S MELBOURNE STREET, SALT LAKE, UT 84106
(801) 467-4637
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
110220-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699878942
UDOH CFHS
UT
05
—
999000021002
—
UT
Enumeration date
10/02/2006
Last updated
07/09/2007
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