Provider Demographics
NPI:1124520044
Name:AHUNA, MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AHUNA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 100 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-5502
Mailing Address - Country:US
Mailing Address - Phone:385-217-5699
Mailing Address - Fax:855-564-1778
Practice Address - Street 1:8706 S 700 E STE 101
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1809
Practice Address - Country:US
Practice Address - Phone:385-217-5699
Practice Address - Fax:855-564-1778
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13264942-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist