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General NPI Number Information
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NPI Number | 1194022418
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Entity Type | Organization
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Legal Business Name | KEVIN CHURCH PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 5255 S 4015 W SUITE 205
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-4257
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Country | US
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Telephone | 801-957-1797
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Fax | 801-957-1941
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Provider Business Mailing Address
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Address Line | 5255 S 4015 W SUITE 205
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-4257
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Country | US
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Telephone | 801-957-1797
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Fax | 801-957-1941
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | KEVIN D CHURCH
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Credential | P.T.
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Telephone | 801-957-1797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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