Provider Demographics
NPI:1487221396
Name:KHO, JUSTEN M (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTEN
Middle Name:M
Last Name:KHO
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 1:13358 S 5600 W
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6789
Mailing Address - Country:US
Mailing Address - Phone:801-302-7230
Mailing Address - Fax:801-302-7237
Practice Address - Street 1:13358 S 5600 W
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6789
Practice Address - Country:US
Practice Address - Phone:801-302-7230
Practice Address - Fax:801-302-7237
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12315097-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist