Provider Demographics
NPI:1083831739
Name:HOTTON, COREY (PTA)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:HOTTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 VALLEY MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5075
Mailing Address - Country:US
Mailing Address - Phone:801-964-3903
Mailing Address - Fax:801-964-3635
Practice Address - Street 1:4155 W PIONEER PARKWAY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-0000
Practice Address - Country:US
Practice Address - Phone:801-964-3903
Practice Address - Fax:801-964-3635
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant