Provider Demographics
NPI:1649337049
Name:TRUJILLO, AMY LORRAINE (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LORRAINE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 S 700 E
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1810
Mailing Address - Country:US
Mailing Address - Phone:801-561-4121
Mailing Address - Fax:801-561-1540
Practice Address - Street 1:8899 S 700 E
Practice Address - Street 2:SUITE 130
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1810
Practice Address - Country:US
Practice Address - Phone:801-561-4121
Practice Address - Fax:801-561-1540
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
X48009Medicare UPIN
UT005569501Medicare ID - Type Unspecified