Healthcare Provider Details

I. General information

NPI: 1114732377
Provider Name (Legal Business Name): PRESTIGE REHAB UT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 S STATE ST STE 310
OREM UT
84097-7045
US

IV. Provider business mailing address

20 COUNTRY CLUB LN
COLTS NECK NJ
07722-2222
US

V. Phone/Fax

Practice location:
  • Phone: 908-670-7573
  • Fax:
Mailing address:
  • Phone: 908-670-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DANIEL REIZIS
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 908-670-7573