Healthcare Provider Details

I. General information

NPI: 1780956615
Provider Name (Legal Business Name): SOUTH CENTRAL THERAPIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 S MAIN ST
MONROE UT
84754-4122
US

IV. Provider business mailing address

52 S MAIN ST
MONROE UT
84754-4122
US

V. Phone/Fax

Practice location:
  • Phone: 435-527-1800
  • Fax: 435-527-1801
Mailing address:
  • Phone: 435-527-1800
  • Fax: 435-527-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number121629-2401
License Number StateUT

VIII. Authorized Official

Name: DANIEL J BRUSE
Title or Position: VICE PRESIDENT
Credential: PT
Phone: 435-529-2234