Provider Demographics
NPI:1790977692
Name:PAGNANI, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PAGNANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 N HIGHWAY 36
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8174
Mailing Address - Country:US
Mailing Address - Phone:435-553-4969
Mailing Address - Fax:435-554-0515
Practice Address - Street 1:6727 N HIGHWAY 36 STE 300
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-9525
Practice Address - Country:US
Practice Address - Phone:435-553-4969
Practice Address - Fax:435-554-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6186311-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist