Healthcare Provider Details

I. General information

NPI: 1134457823
Provider Name (Legal Business Name): SOUTHERN UTAH PHYSICAL THERAPY & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S BENTLEY BLVD
CEDAR CITY UT
84720-1887
US

IV. Provider business mailing address

990 S BENTLEY BLVD
CEDAR CITY UT
84720-1887
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-8024
  • Fax: 435-867-8034
Mailing address:
  • Phone: 435-867-8024
  • Fax: 435-867-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier528193197041
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MR. GAIL TYLER BRINKERHOFF
Title or Position: PART OWNER
Credential: MSPT
Phone: 435-867-8024