Provider Demographics
NPI:1053153940
Name:BIERMAN, JEANETTE (DPT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:BIERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 N KILLYONS LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1716
Mailing Address - Country:US
Mailing Address - Phone:801-201-4481
Mailing Address - Fax:
Practice Address - Street 1:4179 S RIVERBOAT RD STE 110
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-2595
Practice Address - Country:US
Practice Address - Phone:801-337-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13979884-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist