MEDICARE: GATEWAY PHYSICAL THERAPY AND SPORTS REHAB

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

General Provider Information

NPI Number	:	1275098998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY PHYSICAL THERAPY AND SPORTS REHAB

Provider Business Mailing Address
First Line	:	169 N GATEWAY DR STE 160
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9882
Country	:	US
Telephone Number	:	435-799-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 N GATEWAY DR STE 160
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9707
Country	:	US
Telephone Number	:	435-799-3111
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DARIN CHASE
Credential	:
Telephone Number	:	435-799-3111

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	06/09/2022

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Directions to “GATEWAY PHYSICAL THERAPY AND SPORTS REHAB ” Practice Location

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