Healthcare Provider Details

I. General information

NPI: 1275726788
Provider Name (Legal Business Name): DELTA PHYSICAL THERAPY AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 S HIGHWAY 99 SUITE A
FILLMORE UT
84631
US

IV. Provider business mailing address

95 WHITE SAGE AVE STE C
DELTA UT
84624-5555
US

V. Phone/Fax

Practice location:
  • Phone: 435-743-6100
  • Fax: 435-743-6161
Mailing address:
  • Phone: 435-864-2551
  • Fax: 435-864-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD QUACKENBUSH
Title or Position: PRESIDENT
Credential: D.P.T.
Phone: 435-864-2551