Provider Demographics
NPI:1285612697
Name:FELT, JAMES GORDON (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GORDON
Last Name:FELT
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5734 S 1475 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4596
Mailing Address - Country:US
Mailing Address - Phone:801-475-7628
Mailing Address - Fax:801-475-7639
Practice Address - Street 1:5734 SOUTH 1475 EAST
Practice Address - Street 2:#300
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4698
Practice Address - Country:US
Practice Address - Phone:801-475-7628
Practice Address - Fax:801-475-7639
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102840-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000066812Medicare PIN