Healthcare Provider Details

I. General information

NPI: 1811882087
Provider Name (Legal Business Name): PHYSICAL THERAPY RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 S 900 E STE 100
MIDVALE UT
84047-1761
US

IV. Provider business mailing address

1515 E FORT UNION BLVD
COTTONWOOD HEIGHTS UT
84121-2855
US

V. Phone/Fax

Practice location:
  • Phone: 801-755-7181
  • Fax:
Mailing address:
  • Phone: 801-755-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PEDRO LIRA
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 801-755-7181