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1982776530

NPI Code Detail

MEDICARE: ALPINE SPORTS MEDICINE LLC

MEDICARE: ALPINE SPORTS MEDICINE 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	225100000X	Physical Therapist	849822401	UT
2	225100000X	Physical Therapist	49452432401	UT
3	225100000X	Physical Therapist	2832592401	UT
4	225X00000X	Occupational Therapist	2634904201	UT
5	225100000X	Physical Therapist	3296682401	UT

General Provider Information

NPI Number	:	1982776530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE SPORTS MEDICINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 682226
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84068-2226
Country	:	US
Telephone Number	:	435-658-4691
Fax Number	:	435-658-4691

Provider Business Practice Location Address
First Line	:	2015 SIDEWINDER DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7323
Country	:	US
Telephone Number	:	435-645-9095
Fax Number	:	435-645-9092

Authorized Official
Title or Position	:	PARTNER
Name	:	ANDREA P. TERWILLEGAR
Credential	:
Telephone Number	:	435-645-9095

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/17/2014

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Directions to “ALPINE SPORTS MEDICINE 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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