Provider Demographics
NPI:1881621076
Name:THALMAN, JARED MELVIN (PT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MELVIN
Last Name:THALMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-5500
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:888-965-5187
Practice Address - Street 1:20 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-5500
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:888-965-5187
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4737147-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1356470009OtherCENTRAL UTAH PHYSICAL THERAPY SERVICES, INC.
UT000055197OtherMEDICARE PTAN
UT107009134101OtherSELECT HEALTH
UT64189OtherPEHP
UTQM0000048212OtherJAS INC.
UTD3538Medicaid
UT870384752005Medicaid
UTD3538Medicaid