Loupel Superficial Antiquiera
Individual provider Active NPI Physical Therapist · Salt Lake City, UT
NPI 1104123363 · NPPES record last updated Feb 23, 2011
Key facts
- NPI
- 1104123363
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT60024755 (WA)
- Practice address
- 1952 E 7000 S Ste 100
Salt Lake City, UT 84121-6878 - Phone
- (801) 942-3311
- Fax
- (801) 942-5955
- NPI assigned
- Feb 23, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT60024755 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brighton Rehabilitation Agency LLC | Physical Therapist | Past | Accepting new patients |
| Brighton Rehabilitation LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60024755 | WA | Yes |
Addresses
Primary practice location
1952 E 7000 S Ste 100
Salt Lake City, UT 84121-6878
Mailing address
PO Box 711185
Salt Lake City, UT 84171-1185
Phone (801) 942-3311
Other providers in Salt Lake City, UT
- David Alan Anson
- Isaac Anthony
- Layfe Robert Anthony
- Meghan Anthony
- James Antinori
- Margaret Antiquiera
- Marja E Anton
- Anisha Antony
- Michelle Anumba
- Shumaila Anwer
All providers in Salt Lake City, UT · Physical Therapist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.