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

Tyson Ray Fernstrom, DPT

Individual provider Physical Therapist · NPI 1689330847

Tyson Ray Fernstrom, DPT is a Physical Therapist in Private Practice in Eagle Mountain, Utah. Qualified in 2021, 5 years ago. Practices with Jerl Inc, a 9-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
5
Licensed in
UT
In the registry since
2021
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

4095 E Pony Express Pwky Ste 6
Eagle Mountain, UT 84005
Phone: (801) 459-7545
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 14282651-2401 (UT)

Record details

NPI number1689330847
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedNovember 11, 2021
Last updated in NPPESJuly 29, 2026
Certification dateJuly 29, 2026
Mailing address4095 E Pony Express Pwky, Ste 6, Eagle Mountain, UT 84005

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Jerl Inc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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