Provider Demographics
NPI:1558343533
Name:GREENWOOD, MICHAEL JONATHAN (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PT, MS
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Mailing Address - Street 1:3785 HARRISON BLVD.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2071
Mailing Address - Country:US
Mailing Address - Phone:801-778-0555
Mailing Address - Fax:801-778-0080
Practice Address - Street 1:3785 HARRISON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2071
Practice Address - Country:US
Practice Address - Phone:801-778-0555
Practice Address - Fax:801-778-0080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT348999-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000075876OtherALTIUS
UT107010498101OtherINERMOUNTAIN HEALTHCARE
UT42384OtherGEM
UT47730OtherPUBLIC EMPLOYEE HEALTH
UT6400165OtherUNITED HEALTH CARE