Provider Demographics
NPI:1144412420
Name:MAGNUSON, KAMERON (DPT)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:MAGNUSON
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 1:1490 E FOREMASTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4492
Mailing Address - Country:US
Mailing Address - Phone:435-652-4455
Mailing Address - Fax:435-652-4472
Practice Address - Street 1:1490 E FOREMASTER DR STE 110
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4492
Practice Address - Country:US
Practice Address - Phone:435-652-4455
Practice Address - Fax:435-652-4472
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62502992401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist