Provider Demographics
NPI:1639228927
Name:SHINGLETON, ROBERT WILLARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLARD
Last Name:SHINGLETON
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 1:1770 MEADOW DOWNS WAY
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2963
Mailing Address - Country:US
Mailing Address - Phone:801-793-6775
Mailing Address - Fax:
Practice Address - Street 1:1770 MEADOW DOWNS WAY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2963
Practice Address - Country:US
Practice Address - Phone:801-793-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275437-24012251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000074461OtherPTAN