Provider Demographics
NPI:1588730220
Name:AGUIRRE, DAMON L (PT)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:L
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 S 700 E
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6604
Mailing Address - Country:US
Mailing Address - Phone:801-432-2200
Mailing Address - Fax:801-432-2202
Practice Address - Street 1:11760 S 700 E
Practice Address - Street 2:SUITE 112
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6604
Practice Address - Country:US
Practice Address - Phone:801-432-2200
Practice Address - Fax:801-432-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT283805-2401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1604Medicaid
UT000069043Medicare PIN
UT466502Medicare ID - Type Unspecified