MEDICARE: CORE REHABILITATION AND SPINE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	6002870-0160	UT

General Provider Information

NPI Number	:	1093810251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE REHABILITATION AND SPINE CENTER

Provider Business Mailing Address
First Line	:	4885 S 900 E
Second Line	:	SUITE 107
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5746
Country	:	US
Telephone Number	:	801-979-4722
Fax Number	:

Provider Business Practice Location Address
First Line	:	4885 S 900 E
Second Line	:	SUITE 107
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5746
Country	:	US
Telephone Number	:	801-979-4722
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IRENE ACEVEDO
Credential	:	MS, PT, CERT MDT
Telephone Number	:	801-979-4722

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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