Provider Demographics
NPI:1003053596
Name:CHYNOWETH, TODD (RPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:CHYNOWETH
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E 9400 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3632
Mailing Address - Country:US
Mailing Address - Phone:801-576-6417
Mailing Address - Fax:801-576-7536
Practice Address - Street 1:850 EAST 9400 SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:801-576-6417
Practice Address - Fax:801-576-7536
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT276912-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist