Provider Demographics
NPI:1972605012
Name:MAUDSLEY, MICHAEL STEVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:MAUDSLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:STE 107
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4946
Mailing Address - Country:US
Mailing Address - Phone:801-298-2414
Mailing Address - Fax:801-296-1602
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:STE 107
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-298-2414
Practice Address - Fax:801-296-1602
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1083152401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6685Medicare ID - Type Unspecified