Provider Demographics
NPI:1629662853
Name:WOOTTON, GERALD (MPT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:WOOTTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8316
Mailing Address - Country:US
Mailing Address - Phone:801-702-7718
Mailing Address - Fax:801-927-6236
Practice Address - Street 1:1203 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8316
Practice Address - Country:US
Practice Address - Phone:801-702-7718
Practice Address - Fax:801-927-6236
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281895-2401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation