Provider Demographics
NPI:1699539478
Name:THORESON, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:THORESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 W KIMBER LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4312
Mailing Address - Country:US
Mailing Address - Phone:801-577-2205
Mailing Address - Fax:
Practice Address - Street 1:5872 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1679
Practice Address - Country:US
Practice Address - Phone:801-747-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9297897-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist