Provider Demographics
NPI:1114433935
Name:TERRY C SAWCHUK, MD, PC
Entity Type:Organization
Organization Name:TERRY C SAWCHUK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAWCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-232-1404
Mailing Address - Street 1:5770 S 250 E STE 135
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8241
Mailing Address - Country:US
Mailing Address - Phone:801-550-8737
Mailing Address - Fax:801-314-2345
Practice Address - Street 1:5770 S 250 E STE 135
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8241
Practice Address - Country:US
Practice Address - Phone:801-550-8737
Practice Address - Fax:801-314-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT182275-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty