Provider Demographics
NPI:1902988918
Name:JEX, HEIDI H (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:H
Last Name:JEX
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 E 1400 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2265
Mailing Address - Country:US
Mailing Address - Phone:801-525-0007
Mailing Address - Fax:
Practice Address - Street 1:1659 E 1400 S
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2265
Practice Address - Country:US
Practice Address - Phone:801-525-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116671-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ62258Medicare UPIN