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General NPI Number Information
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NPI Number | 1396802617
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Entity Type | Organization
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Legal Business Name | HEBER VALLEY PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 190 N MAIN ST
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City | HEBER CITY
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State | UT
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Zip | 84032-1600
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Country | US
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Telephone | 435-654-0804
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Fax | 435-654-3314
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Provider Business Mailing Address
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Address Line | PO BOX 13
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City | HEBER CITY
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State | UT
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Zip | 84032-0013
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Country | US
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Telephone | 435-654-0804
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Fax | 435-654-3314
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIS K CLYDE
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Credential | P.T.
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Telephone | 435-654-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 117343-2401
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License Number State | UT
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