Provider Demographics
NPI:1336583715
Name:OSTLER, MAYA J (BSPT)
Entity Type:Individual
Prefix:MS
First Name:MAYA
Middle Name:J
Last Name:OSTLER
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3905
Mailing Address - Country:US
Mailing Address - Phone:801-294-0475
Mailing Address - Fax:
Practice Address - Street 1:8 TH AVE C ST
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84134-0001
Practice Address - Country:US
Practice Address - Phone:801-408-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264533-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic