Healthcare Provider Details

I. General information

NPI: 1780894485
Provider Name (Legal Business Name): WASATCH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N 650 W STE A
FARMINGTON UT
84025-2603
US

IV. Provider business mailing address

5349 ADAMS AVE PKWY STE A
OGDEN UT
84405-4736
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-9627
  • Fax: 385-988-3198
Mailing address:
  • Phone: 801-479-9865
  • Fax: 801-479-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL JENKINS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 801-479-9865