Provider Demographics
NPI:1063125946
Name:ARBON, NICKOLAS
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:ARBON
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 1:376 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9646
Mailing Address - Country:US
Mailing Address - Phone:435-849-5688
Mailing Address - Fax:
Practice Address - Street 1:358 N 1100 E # 4
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3250
Practice Address - Country:US
Practice Address - Phone:385-304-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13150072-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist