Provider Demographics
NPI:1093716680
Name:WIXOM, STEVEN M (PT, DPT, CHT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:WIXOM
Suffix:
Gender:M
Credentials:PT, DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:#100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6657
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:702 E SOUTH TEMPLE
Practice Address - Street 2:#102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1204
Practice Address - Country:US
Practice Address - Phone:801-328-8535
Practice Address - Fax:801-364-1242
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275343-24012251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCJ9402OtherRAILROAD MEDICARE
UT27534324000001OtherBLUE CROSS BLUE SHIELD
UT6400654OtherUNITED HEALTHCARE
UT69156OtherPEHP
UT5417OtherDMBA
UT1108540001OtherCIGNA DMERC
UT870388269BR1OtherEDUCATORS MUTUAL
UTCJ9402OtherRAILROAD MEDICARE
UT6400654OtherUNITED HEALTHCARE
UT005580706Medicare ID - Type Unspecified