Provider Demographics
NPI:1528303351
Name:KLOTZER, REBECCA SUE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:KLOTZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5063 S COTTONWOOD ST
Mailing Address - Street 2:STE 120
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6766
Mailing Address - Country:US
Mailing Address - Phone:801-507-1800
Mailing Address - Fax:
Practice Address - Street 1:5063 S COTTONWOOD ST
Practice Address - Street 2:STE 120
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6766
Practice Address - Country:US
Practice Address - Phone:801-507-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294664-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant