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NPI Code Detail

MEDICARE: ALTA THERAPIES LC

MEDICARE: ALTA THERAPIES LC
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist
4261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1962522078
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTA THERAPIES LC
Provider Business Mailing Address
First Line : 598 W 900 S STE 240
Second Line :
City : WOODS CROSS
State : UT
Zip : 84010-8195
Country : US
Telephone Number : 801-693-2301
Fax Number : 801-693-2390
Provider Business Practice Location Address
First Line : 1481 E 1450 S
Second Line :
City : CLEARFIELD
State : UT
Zip : 84015-1610
Country : US
Telephone Number : 801-693-2303
Fax Number : 801-693-2391
Authorized Official
Title or Position : GENERAL MANAGER
Name : MR. DUSTIN CRAGUN
Credential :
Telephone Number : 801-693-2301
Provider Enumeration Date : 03/30/2007
Last Update Date : 10/23/2019

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Directions to “ALTA THERAPIES LC ” Practice Location

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