Healthcare Provider Details

I. General information

NPI: 1154957843
Provider Name (Legal Business Name): MOUNTAIN VIEW THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 S HIGHLAND DR
SALT LAKE CITY UT
84106-3211
US

IV. Provider business mailing address

947 S 500 E STE 105
AMERICAN FORK UT
84003-3392
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-7638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ERIC MYERS
Title or Position: OWNER
Credential:
Phone: 801-709-4358