Provider Demographics
NPI:1073884771
Name:SEDGWICK, DANIEL J (DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:SEDGWICK
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711185
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-1185
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:3072 W 300 N
Practice Address - Street 2:SUITE A
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-3933
Practice Address - Country:US
Practice Address - Phone:801-825-7500
Practice Address - Fax:801-825-7511
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6955200-48102255A2300X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer