Provider Demographics
NPI:1326178807
Name:DANGERFIELD, TAMARA A (PT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:DANGERFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 S 440 E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:546 CHIPETA WAY
Practice Address - Street 2:SUITE # 220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1236
Practice Address - Country:US
Practice Address - Phone:801-581-7246
Practice Address - Fax:801-581-6243
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0285884-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist