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General NPI Number Information
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NPI Number | 1730701483
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Entity Type | Organization
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Legal Business Name | FORWARD REHAB
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 2100 PARK AVE # 683745
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City | PARK CITY
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State | UT
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Zip | 84060-8100
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Country | US
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Telephone | 206-795-4360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 683745
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City | PARK CITY
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State | UT
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Zip | 84068-3745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLY BROOKS
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Credential | PT, DPT
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Telephone | 206-795-4360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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