Provider Demographics
NPI:1851916787
Name:GERBER, JONATHAN DAX (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAX
Last Name:GERBER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 1030 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4534
Mailing Address - Country:US
Mailing Address - Phone:509-818-9989
Mailing Address - Fax:435-200-3934
Practice Address - Street 1:3460 S REDWOOD RD STE 3
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3400
Practice Address - Country:US
Practice Address - Phone:385-255-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10533080-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist