MEDICARE: BACK AT WORK OF UTAH 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1902423049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK AT WORK OF UTAH LLC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	772 E 700 S STE 3
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1215
Country	:	US
Telephone Number	:	801-217-3755
Fax Number	:	801-217-3850

Authorized Official
Title or Position	:	CFO
Name	:	THOMAS BRYAN BARGANIER
Credential	:
Telephone Number	:	205-536-7602

Provider Enumeration Date	:	07/05/2020
Last Update Date	:	10/22/2020

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Directions to “BACK AT WORK OF UTAH LLC ” Practice Location

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