Healthcare Provider Details

I. General information

NPI: 1891129821
Provider Name (Legal Business Name): MOAB PHYSICAL THERAPY AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E 100 S
MOAB UT
84532-2641
US

IV. Provider business mailing address

131 E 100 S
MOAB UT
84532-2641
US

V. Phone/Fax

Practice location:
  • Phone: 435-210-1985
  • Fax: 435-355-0410
Mailing address:
  • Phone: 435-210-1985
  • Fax: 435-355-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8212548-2401
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier0
Identifier TypeOTHER
Identifier State
Identifier IssuerNO ADDITIONAL NUMBER TO ENTER

VIII. Authorized Official

Name: RHONDA GRACE COWERN
Title or Position: PHYSCIAL THERAPIST
Credential: D.P.T.
Phone: 435-210-1985