MEDICARE: FIRST MED EAST PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	110326-2401	UT

General Provider Information

NPI Number	:	1386662823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST MED EAST PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 702128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84170-2128
Country	:	US
Telephone Number	:	801-708-7867
Fax Number	:	801-677-1510

Provider Business Practice Location Address
First Line	:	1950 FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6894
Country	:	US
Telephone Number	:	801-943-1041
Fax Number	:	801-943-3461

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL G WORTLEY
Credential	:	PT
Telephone Number	:	801-417-5017

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/06/2010

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