Provider Demographics
NPI:1629827498
Name:HOUGHTON, ALEXIS JERON (PT, DPT, MS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JERON
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 W AMINI WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9269
Mailing Address - Country:US
Mailing Address - Phone:801-367-7625
Mailing Address - Fax:
Practice Address - Street 1:11760 S 700 E STE 211
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6605
Practice Address - Country:US
Practice Address - Phone:801-456-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13971857-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic