MEDICARE: HOUSE CALL PHYSICAL THERAPY & REHAB, 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	2753722401	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DE2148	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09852155103001	OTHER	UT	BLUE CROSS BLUE SHIELD
2	09852155103001	OTHER	UT	BCBS MEDADVANTAGE
4	QMP000003343017	OTHER	UT	MOLINA

General Provider Information

NPI Number	:	1659545499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE CALL PHYSICAL THERAPY & REHAB, LLC

Provider Business Mailing Address
First Line	:	5406 W LETICIA CT
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-7560
Country	:	US
Telephone Number	:	801-898-5050
Fax Number	:	801-969-3885

Provider Business Practice Location Address
First Line	:	5406 W LETICIA CT
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-7560
Country	:	US
Telephone Number	:	801-898-5050
Fax Number	:	801-969-3885

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSEPH CHARLES CALANDRA
Credential	:	P.T.
Telephone Number	:	801-898-5050

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	06/23/2008

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