Provider Demographics
NPI:1043325715
Name:TOMLINSON, STEPHEN JASON (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JASON
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1424 E FOREMASTER DR STE 120
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5844
Practice Address - Country:US
Practice Address - Phone:435-656-8800
Practice Address - Fax:435-627-1809
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290768-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDD2759OtherRR MEDICARE
UT030551781JT2OtherEDUCATORS MUTUAL
UT107031324102OtherSELECT HEALTH
UT610748900OtherOWCP
UT875082OtherDMBA
UT9374195OtherPHCS
UT233991OtherALTIUS
UT02907682405001OtherBLUE CROSS BLUE SHIELD
UT81821OtherPEHP
UT060551781OtherTRI CARE
UT030551781JT2OtherEDUCATORS MUTUAL
UT610748900OtherOWCP