Active NPI
Micaela Jaramillo
- Physical Therapist
- Salt Lake City, UT
National Provider Identifier
1083120786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9779273-2401
- Practice address
- 1430 E 4500 S
Salt Lake City, UT 84117-4208 - Phone
- (801) 671-2787
- Fax
- (801) 671-2787
- NPI assigned
- Dec 18, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9779273-2401 | UT | Primary |
Addresses
Primary practice location
1430 E 4500 S
Salt Lake City, UT 84117-4208
Mailing address
1352 E Royal Troon Dr Apt 10
Salt Lake City, UT 84124-4125
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9779273-2401 | Other | UT | DIVISION OF OCCUPATION AND PROFESSIONAL LICENSING |
| 221417462 | Other | UT | DRIVERS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9779273-2401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513555200000",
"number": "1083120786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1352 E ROYAL TROON DR APT 10",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841244125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 E 4500 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841174208",
"telephone_number": "801-671-2787",
"fax_number": "801-671-2787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARAMILLO",
"first_name": "MICAELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-18",
"last_updated": "2017-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "9779273-2401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIVISION OF OCCUPATION AND PROFESSIONAL LICENSING",
"identifier": "9779273-2401",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "221417462",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.