Healthcare Provider Details

I. General information

NPI: 1679881379
Provider Name (Legal Business Name): SW REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W 1500 N
NEPHI UT
84648-8900
US

IV. Provider business mailing address

48 W 1500 N
NEPHI UT
84648-8900
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-3045
  • Fax: 435-623-6046
Mailing address:
  • Phone: 435-623-3045
  • Fax: 435-623-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number77405642401
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOHN WILLMORE
Title or Position: PHYSICAL THERAPY DIRECTOR
Credential: PT, CWS
Phone: 435-623-3045