MEDICARE: SANPETE VALLEY PHYSICAL THERAPY LLC

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	225100000X	Physical Therapist	4931765-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107043750101	OTHER	UT	INTERMOUNTAIN HEALTHCARE
2	93822	OTHER	UT	PUBLIC EMPLOYEES HEALTH P
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265623805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANPETE VALLEY PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1104
Country	:	US
Telephone Number	:	435-283-5662
Fax Number	:	435-283-5666

Provider Business Practice Location Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1104
Country	:	US
Telephone Number	:	435-283-5662
Fax Number	:	435-283-5666

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT M RASMUSSEN
Credential	:	P.T.
Telephone Number	:	435-283-5662

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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