Healthcare Provider Details

I. General information

NPI: 1124941596
Provider Name (Legal Business Name): INNATE PHYSICAL THERAPY & SPORT MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E 100 N STE 3
PAYSON UT
84651-2387
US

IV. Provider business mailing address

887 E 100 N STE 3
PAYSON UT
84651-2387
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-7298
  • Fax:
Mailing address:
  • Phone: 801-369-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CRITCHFIELD
Title or Position: OWNER
Credential:
Phone: 801-369-7298