Individual
GREGORY EDWARD RICKENBACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
370 E SOUTH TEMPLE STE 150, SALT LAKE CITY, UT 84111-1279
(801) 521-9222
Mailing address
1176 E 3745 S, SALT LAKE CITY, UT 84106-2443
(978) 886-7937
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12615050-2401
UT
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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