Healthcare Provider Details

I. General information

NPI: 1477705010
Provider Name (Legal Business Name): SOUTH MOUNTAIN PT & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 SOUTH 900 EAST SUITE 100
MIDVALE UT
84047-1753
US

IV. Provider business mailing address

6770 SOUTH 900 EAST SUITE 100
MIDVALE UT
84047-1753
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-8242
  • Fax: 801-523-8242
Mailing address:
  • Phone: 801-523-8242
  • Fax: 801-523-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number323505-2401
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JAMES D. HARRISON
Title or Position: OWNER
Credential: PT
Phone: 801-523-6376