Provider Demographics
NPI:1720054794
Name:IRIYE, TOM T (AT,C)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:T
Last Name:IRIYE
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10744 S 1120 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5091
Mailing Address - Country:US
Mailing Address - Phone:801-585-7044
Mailing Address - Fax:801-581-8290
Practice Address - Street 1:1825 E SOUTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-0900
Practice Address - Country:US
Practice Address - Phone:801-585-7044
Practice Address - Fax:801-581-8290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer