Healthcare Provider Details

I. General information

NPI: 1346895935
Provider Name (Legal Business Name): POSITIONAL RELEASE THERAPY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 E. 5600 S.
OGDEN UT
84403
US

IV. Provider business mailing address

1702 E. 5600 S.
OGDEN UT
84403
US

V. Phone/Fax

Practice location:
  • Phone: 801-689-2546
  • Fax: 385-206-8657
Mailing address:
  • Phone: 801-689-2546
  • Fax: 385-206-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY EUGENE SPEICHER
Title or Position: PRESIDENT
Credential: PHD, ATC, LAT, CSCS,
Phone: 801-689-2546