MEDICARE: C3 PHYSICAL THERAPY AND HEALTH & WELLNESS SERVICES

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

General Provider Information

NPI Number	:	1346898566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C3 PHYSICAL THERAPY AND HEALTH & WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	2906 W HAZELNUT CIR
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-2432
Country	:	US
Telephone Number	:	323-572-6468
Fax Number	:	801-618-1822

Provider Business Practice Location Address
First Line	:	6216 S REDWOOD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-6630
Country	:	US
Telephone Number	:	801-252-6995
Fax Number	:	801-618-1822

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	CLARISSA CARINO CELESTINO
Credential	:	PT
Telephone Number	:	801-252-6995

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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