MEDICARE: H2 PHYSICAL THERAPY

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	:	1700450806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H2 PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	560 W 465 N STE 604
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-8006
Country	:	US
Telephone Number	:	435-753-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 N 400 E STE B
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1799
Country	:	US
Telephone Number	:	435-760-0915
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY D HUNTER
Credential	:	PT
Telephone Number	:	435-760-0915

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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Directions to “H2 PHYSICAL THERAPY ” Practice Location

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