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General NPI Number Information
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NPI Number | 1790898930
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Entity Type | Organization
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Legal Business Name | SPORTS & ORTHOPEDIC PHYSICAL THERAPY OF KAYSVILLE LC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1188 SPORTSPLEX DR STE. 101
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City | KAYSVILLE
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State | UT
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Zip | 84037-9591
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Country | US
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Telephone | 801-547-1155
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Fax | 801-547-1173
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Provider Business Mailing Address
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Address Line | PO BOX 711185
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City | SALT LAKE CITY
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State | UT
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Zip | 84171-1185
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Country | US
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Telephone | 801-942-3311
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Fax | 801-942-5955
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK ANDERSON
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Credential | PT
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Telephone | 801-942-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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