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General NPI Number Information
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NPI Number | 1932673126
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Entity Type | Organization
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Legal Business Name | EXERGY REHABILITATION
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 196 E CENTER STREET SUITE 4
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City | BLANDING
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State | UT
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Zip | 84511
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Country | US
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Telephone | 336-692-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 293 N 100 W
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City | BLANDING
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State | UT
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Zip | 84511-3620
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Country | US
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Telephone | 336-618-0595
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | LAURA LYON TIMMERMAN
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Credential | MPT
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Telephone | 336-692-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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