Provider Demographics
NPI:1487998431
Name:UTAH PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:UTAH PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, VP, COO, CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-689-0200
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-0066
Mailing Address - Country:US
Mailing Address - Phone:801-689-0200
Mailing Address - Fax:801-689-0201
Practice Address - Street 1:3476 W 4600 S
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9203
Practice Address - Country:US
Practice Address - Phone:801-689-0200
Practice Address - Fax:801-689-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0701426657Medicaid