Individual
JERAMIAH FORTUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
13747 REDWOOD RD, RIVERTON, UT 84065
(801) 938-9806
(801) 417-9399
Mailing address
P.O. BOX 711185, SALT LAKE CITY, UT 84121
(801) 942-3311
(801) 942-5955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4985050-2401
UT
Other
Enumeration date
12/18/2008
Last updated
01/14/2013
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