Healthcare Provider Details

I. General information

NPI: 1487998753
Provider Name (Legal Business Name): J ADELLE TWIBEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S VICTORY WAY
BIG WATER UT
84741-7707
US

IV. Provider business mailing address

PO BOX 410111
BIG WATER UT
84741-2111
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-5341
  • Fax:
Mailing address:
  • Phone: 801-589-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-31555
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number116591-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: