Healthcare Provider Details

I. General information

NPI: 1700985249
Provider Name (Legal Business Name): WASATCH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 S ADAMS AVE SUITE A
OGDEN UT
84405-4736
US

IV. Provider business mailing address

5349 ADAMS AVE PKWY STE A
OGDEN UT
84405-4736
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-9865
  • Fax: 801-479-5846
Mailing address:
  • Phone: 801-479-9865
  • Fax: 801-479-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109421-2401
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5936026-2401
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5946448-2401
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number274724-2401
License Number StateUT

VIII. Authorized Official

Name: JILL JENKINS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 801-479-9865