Healthcare Provider Details

I. General information

NPI: 1275624793
Provider Name (Legal Business Name): GARN LOVELAND PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/14/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N WYMOUNT TERRACE DR 2300 SHC
PROVO UT
84602
US

IV. Provider business mailing address

3319 N UNIVERSITY AVE STE 100
PROVO UT
84604-4447
US

V. Phone/Fax

Practice location:
  • Phone: 801-356-0014
  • Fax: 801-788-4842
Mailing address:
  • Phone: 503-799-6743
  • Fax: 801-788-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3443
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number277510-6004
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier181519
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOMAP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: