Healthcare Provider Details

I. General information

NPI: 1609073741
Provider Name (Legal Business Name): PEAK REHABILITATION AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6782 S 1300 E
SALT LAKE CITY UT
84121-2719
US

IV. Provider business mailing address

6782 S 1300 E
SALT LAKE CITY UT
84121-2719
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-0240
  • Fax: 801-568-9336
Mailing address:
  • Phone: 801-568-0240
  • Fax: 801-568-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6262252-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number5571167-2401
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5132199-2401
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5132199-2401
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5571167-2401
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6262252-2401
License Number StateUT

VIII. Authorized Official

Name: MR. BARTLEY BRETT MORTENSEN
Title or Position: PRESIDENT
Credential: MS, PT, ATC
Phone: 801-568-0240