Provider Demographics
NPI:1376716787
Name:NIELSEN, RICHARD PAGE (PT, DHSC, ECS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAGE
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:PT, DHSC, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 EAST 10,000 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-1111
Mailing Address - Country:US
Mailing Address - Phone:801-423-1147
Mailing Address - Fax:801-375-2125
Practice Address - Street 1:52 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-465-6911
Practice Address - Fax:801-465-1617
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75-107648-2401225100000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical