Provider Demographics
NPI:1487769089
Name:MYSHRALL, JANET (PT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MYSHRALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6160
Mailing Address - Country:US
Mailing Address - Phone:435-901-3579
Mailing Address - Fax:435-658-9934
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:SUITE 4I
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1377
Practice Address - Country:US
Practice Address - Phone:435-901-3579
Practice Address - Fax:435-658-9934
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290437-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057199Medicare ID - Type Unspecified