Provider Demographics
NPI:1497803746
Name:KRAHENBUHL, DOUGLAS WALTER (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WALTER
Last Name:KRAHENBUHL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7998 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0744
Mailing Address - Country:US
Mailing Address - Phone:801-553-9330
Mailing Address - Fax:801-352-7185
Practice Address - Street 1:7998 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-0744
Practice Address - Country:US
Practice Address - Phone:801-553-9330
Practice Address - Fax:801-352-7185
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116656-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist