Healthcare Provider Details

I. General information

NPI: 1619467198
Provider Name (Legal Business Name): HIGH MOUNTAIN PHYSICAL THERAPY AND PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 100 S
HATCH UT
84735-7786
US

IV. Provider business mailing address

PO BOX 457
HATCH UT
84735-0457
US

V. Phone/Fax

Practice location:
  • Phone: 385-275-2977
  • Fax:
Mailing address:
  • Phone: 435-708-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JASON BARNEY
Title or Position: OWNER
Credential: DPT
Phone: 435-708-1923