Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Justin D. Provo, MD

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1720548670

Justin D. Provo, MD is a Physical Medicine and Rehabilitation in Salt Lake City, Utah. Graduated from University of New Mexico School of Medicine in 2019, 7 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
7
Trained at
University of New Mexico School of Medicine
Licensed in
UT
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

30 N 1900 E Rm 1C301
Salt Lake City, UT 84132-0002
Phone: (801) 585-2589
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence 12017642-1205 (UT)

Record details

NPI number1720548670
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 25, 2019
Last updated in NPPESNovember 5, 2020
Certification dateNovember 5, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL MEDICINE AND REHABILITATION
Medical schoolUNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduated 2019 (7 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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