Healthcare Provider Details

I. General information

NPI: 1275466864
Provider Name (Legal Business Name): ANDREW CHASE TOLLEFSON DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDY CHASE TOLLEFSON DPT, CSCS

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

1590 E SPRING RUN DR
HOLLADAY UT
84117-6855
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 320-444-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14287890-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: