Healthcare Provider Details

I. General information

NPI: 1992980890
Provider Name (Legal Business Name): NORTHERN PHYSICAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E 5800 S
OGDEN UT
84405-7139
US

IV. Provider business mailing address

9070 W CHEYENNE AVE STE 100
LAS VEGAS NV
89129-8935
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-2000
  • Fax: 801-476-7000
Mailing address:
  • Phone: 702-818-5000
  • Fax: 702-818-5001

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 Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC ELDON DOUGLASS
Title or Position: CHIEF CLINICAL OFFICER
Credential:
Phone: 239-947-4184