Provider Demographics
NPI:1326342346
Name:JORGENSEN, JON BURKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:BURKE
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 S MEDICAL CENTER DR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7049
Mailing Address - Country:US
Mailing Address - Phone:435-251-2250
Mailing Address - Fax:435-251-2255
Practice Address - Street 1:652 S MEDICAL CENTER DR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7049
Practice Address - Country:US
Practice Address - Phone:435-251-2250
Practice Address - Fax:435-251-2255
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9255225100000X
UT76544502401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist