Healthcare Provider Details

I. General information

NPI: 1023155322
Provider Name (Legal Business Name): TEAMWORKS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 N 1000 W STE 107
LOGAN UT
84321-3140
US

IV. Provider business mailing address

642 N 1000 W STE 107
LOGAN UT
84321-3140
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-1556
  • Fax: 866-420-3724
Mailing address:
  • Phone: 435-753-1556
  • Fax: 866-420-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2828354201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number275801-2401
License Number StateUT

VIII. Authorized Official

Name: STEFFANIE HANSEN
Title or Position: BILLING MANAGER
Credential:
Phone: 435-753-1556