MEDICARE: INDEPENDENCE REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1063781813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE REHAB, LLC

Provider Business Mailing Address
First Line	:	5314 N RIVER RUN DR STE 140
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7706
Country	:	US
Telephone Number	:	801-426-4905
Fax Number	:	801-426-4953

Provider Business Practice Location Address
First Line	:	5314 N RIVER RUN DR STE 140
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7706
Country	:	US
Telephone Number	:	801-426-4905
Fax Number	:	801-426-4953

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHAD FULLMER
Credential	:
Telephone Number	:	801-494-0486

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	03/24/2026

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Directions to “INDEPENDENCE REHAB, LLC ” Practice Location

Language	Start Address	Practice Location

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