Provider Demographics
NPI:1184736951
Name:FLINDERS, MARK ALAN (PT ATC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:FLINDERS
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711185
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-1185
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:1477 N. 2000 W.
Practice Address - Street 2:STE A
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-9099
Practice Address - Country:US
Practice Address - Phone:801-773-4191
Practice Address - Fax:801-773-4197
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2805562401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4040Medicaid