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NPI Code Detail

MEDICARE: INDEPENDENCE REHAB

MEDICARE: INDEPENDENCE REHAB
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
1235Z00000XSpeech-Language Pathologist
2225X00000XOccupational Therapist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1407982630
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENCE REHAB
Provider Business Mailing Address
First Line : 797 E 640 N
Second Line :
City : LINDON
State : UT
Zip : 84042-1647
Country : US
Telephone Number : 801-426-4905
Fax Number : 801-426-4953
Provider Business Practice Location Address
First Line : 1430 E 4500 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-4208
Country : US
Telephone Number : 801-426-4905
Fax Number : 801-426-4953
Authorized Official
Title or Position : VICE PRESIDENT
Name : CHAD B. FULLMER
Credential :
Telephone Number : 801-635-6602
Provider Enumeration Date : 02/23/2007
Last Update Date : 12/23/2011

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Directions to “INDEPENDENCE REHAB ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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