Healthcare Provider Details

I. General information

NPI: 1184678070
Provider Name (Legal Business Name): THERAPY WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 EAST CENTER
GUNNISON UT
84634-0396
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171-1185
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-7575
  • Fax: 435-528-7000
Mailing address:
  • Phone: 801-942-3311
  • Fax: 801-942-5955

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 Number
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: COURTNEY R LISZKA
Title or Position: CRO
Credential:
Phone: 503-583-5447