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NPI Code Detail

MEDICARE: DYNAMIC PHYSICAL THERAPY LLC

MEDICARE: DYNAMIC 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
1261QP2000XPhysical Therapy Clinic/Center9321575-0160UT

General Provider Information

NPI Number : 1932595691
Entity Type Code : Organization
Provider Name (Legal Business Name) : DYNAMIC PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : 1265 E FORT UNION BLVD
Second Line : STE 110
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1808
Country : US
Telephone Number : 801-849-0198
Fax Number :
Provider Business Practice Location Address
First Line : 1265 E FORT UNION BLVD STE 110
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1807
Country : US
Telephone Number : 801-450-1881
Fax Number :
Authorized Official
Title or Position : PHYSICAL THERAPIST
Name : DR. MATTHEW S NELSON
Credential : PT, DPT
Telephone Number : 801-450-1881
Provider Enumeration Date : 04/09/2015
Last Update Date : 07/03/2015

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Directions to “DYNAMIC PHYSICAL THERAPY LLC ” 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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