Provider Demographics
NPI:1114287612
Name:DEPOLA, MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEPOLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9844 S 1300 E
Mailing Address - Street 2:STE 300
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4693
Mailing Address - Country:US
Mailing Address - Phone:801-572-0690
Mailing Address - Fax:801-572-0696
Practice Address - Street 1:1577 W 7000 S
Practice Address - Street 2:100
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-7492
Practice Address - Country:US
Practice Address - Phone:801-566-6301
Practice Address - Fax:801-566-4739
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6511974-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist