Provider Demographics
NPI:1649474982
Name:SLAUGH, MARK (MPT, ATC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SLAUGH
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N 200 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2001
Mailing Address - Country:US
Mailing Address - Phone:435-789-6757
Mailing Address - Fax:435-789-7892
Practice Address - Street 1:75 N 200 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2001
Practice Address - Country:US
Practice Address - Phone:435-789-6757
Practice Address - Fax:435-789-7892
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34208324012251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports