Provider Demographics
NPI:1114942448
Name:POWERS, TERENCE JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:JOHN
Last Name:POWERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3600
Practice Address - Fax:801-507-3625
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1028241206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS33400Medicare UPIN
UT000065738Medicare PIN