Individual
MR. KENNETH TILLMAN ETHINGTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2707 S ADAMS ST APT 3, SALT LAKE CITY, UT 84115-3350
(435) 668-2083
Mailing address
2707 S ADAMS ST APT 3, SALT LAKE CITY, UT 84115-3350
(435) 668-2083
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
5477970-2402
UT
2251X0800X
Orthopedic Physical Therapist
5477970-2402
UT
Other
Enumeration date
07/11/2013
Last updated
07/11/2013
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