Healthcare Provider Details

I. General information

NPI: 1487672580
Provider Name (Legal Business Name): GRANTSVILLE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 E MAIN ST
GRANTSVILLE UT
84029-2500
US

IV. Provider business mailing address

822 E MAIN ST STE 16
GRANTSVILLE UT
84029-2501
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-1263
  • Fax: 435-884-0930
Mailing address:
  • Phone: 435-884-0324
  • Fax: 435-884-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number117575-2401
License Number StateUT

VIII. Authorized Official

Name: JOHN ROBERT ELMER
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 435-884-0324