Healthcare Provider Details

I. General information

NPI: 1235482977
Provider Name (Legal Business Name): WASATCH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N 700 W STE 240
LAYTON UT
84041-5864
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-784-7373
  • Fax: 801-784-7532
Mailing address:
  • Phone: 801-479-9865
  • Fax: 801-479-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA ARLENE ITA'AEHAU
Title or Position: DPT / OWNER
Credential: PT
Phone: 801-479-9865