Healthcare Provider Details

I. General information

NPI: 1295502029
Provider Name (Legal Business Name): PREVAIL STROKE AND NEURO REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E 3060 S
SALT LAKE CITY UT
84106-3932
US

IV. Provider business mailing address

1910 E 3060 S
SALT LAKE CITY UT
84106-3932
US

V. Phone/Fax

Practice location:
  • Phone: 801-860-3237
  • Fax:
Mailing address:
  • Phone: 801-860-3237
  • 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 Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN HERBERT KINZINGER
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 801-860-3237