Healthcare Provider Details

I. General information

NPI: 1023241361
Provider Name (Legal Business Name): INFINITY REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 SW GREENBURG RD SUITE 201
TIGARD OR
97223-5503
US

IV. Provider business mailing address

273 W 1480 N
TOOELE UT
84074-8994
US

V. Phone/Fax

Practice location:
  • Phone: 503-570-3665
  • Fax:
Mailing address:
  • Phone: 435-882-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number72228482401
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BOB THOMAS
Title or Position: PRESIDENT
Credential: MSPT
Phone: 503-570-3665