# KFDD PHYSICAL THERAPY & SPORTS MEDICINE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sports Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013028505
- **Authorized official:** MR. CHRIS HOLMGREN DAHLBERG P.T. (CORPORATION PRESIDENT, BUSINESS OWN)
- **Authorized official phone:** (801) 621-8835

## Contact information

- **Practice address:** 2261 KIESEL AVE., SUITE \#320, OGDEN, UT 84401-1969
- **Practice address phone:** (801) 621-8835
- **Practice address fax:** (801) 528-5357
- **Mailing address:** 2261 KIESEL AVE., SUITE \#320, OGDEN, UT 84401-1969
- **Mailing address phone:** (801) 621-8835
- **Mailing address fax:** (801) 528-5357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 114380-2401 | UT | — |
| 225100000X | Physical Therapist | 115411-2401 | UT | Yes |
| 2251X0800X | Orthopedic Physical Therapist | 114380-2401 | UT | — |
| 2251X0800X | Orthopedic Physical Therapist | 115411-2401 | UT | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 04/17/2012