Healthcare Provider Details

I. General information

NPI: 1184231664
Provider Name (Legal Business Name): MOUNTAIN STRONG SPINE AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 N 4925 W
PLAIN CITY UT
84404-8300
US

IV. Provider business mailing address

1478 N 4925 W
PLAIN CITY UT
84404-8300
US

V. Phone/Fax

Practice location:
  • Phone: 801-668-1245
  • 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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JACOB KAP
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 801-668-1245