Provider Demographics
NPI:1396357034
Name:MUHN, JEFFERSON MARVIN (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:MARVIN
Last Name:MUHN
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 1:956 S 225 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4167
Mailing Address - Country:US
Mailing Address - Phone:801-580-5562
Mailing Address - Fax:
Practice Address - Street 1:1425 S 1500 E
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1613
Practice Address - Country:US
Practice Address - Phone:801-580-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7961873-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist