Provider Demographics
NPI:1184902801
Name:WASATCH PHYSICAL THERAPY AND REHABILITATION, INC
Entity type:Organization
Organization Name:WASATCH PHYSICAL THERAPY AND REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:801-363-3918
Mailing Address - Street 1:5323 WOODROW ST
Mailing Address - Street 2:#204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5841
Mailing Address - Country:US
Mailing Address - Phone:801-713-0610
Mailing Address - Fax:801-713-0613
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:#105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-355-6468
Practice Address - Fax:801-355-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty