Provider Demographics
NPI:1427119957
Name:JANZEN, REBECCA PINGREE (ATC L)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:PINGREE
Last Name:JANZEN
Suffix:
Gender:F
Credentials:ATC L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 AURORA CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2235
Mailing Address - Country:US
Mailing Address - Phone:801-205-6906
Mailing Address - Fax:
Practice Address - Street 1:9720 S 1300 E
Practice Address - Street 2:#W200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3712
Practice Address - Country:US
Practice Address - Phone:801-572-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6351453-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer