Provider Demographics
NPI:1073546040
Name:MIYASAKI, RODNEY A (PT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:A
Last Name:MIYASAKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5547 SO 4015 W
Mailing Address - Street 2:WESTWOOD PHYSICAL THERAPY CLINIC #7
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4429
Mailing Address - Country:US
Mailing Address - Phone:801-967-6055
Mailing Address - Fax:801-967-6934
Practice Address - Street 1:5547 S 4015 W
Practice Address - Street 2:#7
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-4429
Practice Address - Country:US
Practice Address - Phone:801-967-6055
Practice Address - Fax:801-967-6934
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1079462401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT44035OtherPEHP
UT6400110OtherUHC
UT107000445102OtherPHC
UT265950OtherDMBA
UT42673OtherFIRST HEALTH
UTNO261Medicaid
UT190100500OtherOWCP
UT650013190OtherRR MEDICARE
UTQM0000076206OtherALTIUS
UT3269413001OtherCIGNA
UT42673OtherFIRST HEALTH