Provider Demographics
NPI:1801770953
Name:PHAM, PATRICK PHAM J (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK PHAM
Middle Name:J
Last Name:PHAM
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 1:243 S 2530 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-3650
Mailing Address - Country:US
Mailing Address - Phone:206-972-6003
Mailing Address - Fax:
Practice Address - Street 1:1735 S REDWOOD RD STE 115
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-5107
Practice Address - Country:US
Practice Address - Phone:801-973-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14227722-8016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist