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General NPI Number Information
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NPI Number | 1730777962
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Entity Type | Organization
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Legal Business Name | FORTIFY PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 792 S 3000 E
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City | ST. GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 208-431-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 792 S 3000 E
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City | ST. GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 208-431-0211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON LAYNE HARPER
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Credential | PT
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Telephone | 208-431-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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