Healthcare Provider Details

I. General information

NPI: 1598096083
Provider Name (Legal Business Name): WASATCH PHYSICAL THERAPY & REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 E 400 S
SALT LAKE CITY UT
84102-2903
US

IV. Provider business mailing address

5323 WOODROW ST #204
SALT LAKE CITY UT
84107-5841
US

V. Phone/Fax

Practice location:
  • Phone: 801-363-3918
  • Fax: 801-596-3796
Mailing address:
  • Phone: 801-713-0610
  • Fax: 801-713-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON C HALL
Title or Position: PRESIDENT
Credential: MPT
Phone: 801-713-0610