MEDICARE: INTENSIVE PHYSICAL THERAPY INSTITUTE, 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	261QP2000X	Physical Therapy Clinic/Center	2775252401	UT

General Provider Information

NPI Number	:	1659633691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENSIVE PHYSICAL THERAPY INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0257
Fax Number	:	801-251-0259

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0257
Fax Number	:	801-251-0259

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MURIEL JOAN LEE
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	801-251-0257

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	07/18/2013

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