| Doctor Name: | MARIE DUFRESNE BAMBO |
| NPI Number: | 1063544260 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 117517-2401 |
| Business Practice Address: | 1685 W 2200 S Salt Lake City, UT - 841191456 |
| Business Phone Number: | 8018875455 |
| Business Fax Number: | |
| Mailing Address: | 893 13th Ave, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841033328 |
| Phone Number: | 8015968631 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 117517-2401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |