Provider Demographics
NPI:1730109760
Name:CASPER, JOHN TRENT (MPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TRENT
Last Name:CASPER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:J.
Other - Middle Name:TRENT
Other - Last Name:CASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:3930 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-6300
Mailing Address - Country:US
Mailing Address - Phone:801-442-1501
Mailing Address - Fax:
Practice Address - Street 1:5801 FASHION BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-314-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118612-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist