Provider Demographics
NPI:1336184324
Name:THALMAN, JEFFERY JUDD (PT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JUDD
Last Name:THALMAN
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 1:20 W WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-5500
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:888-965-5187
Practice Address - Street 1:20 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-5500
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:888-965-5187
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5933267-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870384752005Medicaid
UT1356470009OtherCENTRAL UTAH PHYSICAL THERAPY SERVICES, INC.
UT1356470009OtherCENTRAL UTAH PHYSICAL THERAPY SERVICES, INC.