Provider Demographics
NPI:1275970014
Name:TERVORT, DAVID ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ADAM
Last Name:TERVORT
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 1:25 W 990 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3160
Mailing Address - Country:US
Mailing Address - Phone:801-472-3912
Mailing Address - Fax:
Practice Address - Street 1:820 EXPRESSWAY LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1300
Practice Address - Country:US
Practice Address - Phone:801-357-0333
Practice Address - Fax:801-794-9553
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7982532-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist