Provider Demographics
NPI:1952633133
Name:MURDOCH, JESSICA SELU (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SELU
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 E 950 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3314
Mailing Address - Country:US
Mailing Address - Phone:801-380-2191
Mailing Address - Fax:
Practice Address - Street 1:286 E 950 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3314
Practice Address - Country:US
Practice Address - Phone:801-380-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7562205-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer