Provider Demographics
NPI:1649726555
Name:KNUTESON, REESE
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:KNUTESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 E 5300 S
Mailing Address - Street 2:APT A
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:848 E 5300 S
Practice Address - Street 2:APT A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4566
Practice Address - Country:US
Practice Address - Phone:801-822-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer