Healthcare Provider Details

I. General information

NPI: 1750214938
Provider Name (Legal Business Name): SPINE PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 W 1400 N
OREM UT
84057-7000
US

IV. Provider business mailing address

629 W SIDNEY LN
SARATOGA SPRINGS UT
84045-6619
US

V. Phone/Fax

Practice location:
  • Phone: 801-709-4772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES GUBLER
Title or Position: OWNER/PT
Credential: PT
Phone: 740-607-7582