# AMV MOUNTAIN LAND LC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOUNTAIN LAND REHABILITATION, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063429793
- **Legal business name:** MOUNTAIN LAND REHABILITATION, INC
- **Authorized official:** MR. MARK ANDERSON PT (PRESIDENT)
- **Authorized official phone:** (801) 942-3311

## Contact information

- **Practice address:** 355 N MAIN ST, KANAB, UT 84741
- **Practice address phone:** (435) 644-4199
- **Practice address fax:** (435) 644-4141
- **Mailing address:** PO BOX 711185, SALT LAKE CITY, UT 84171
- **Mailing address phone:** (801) 942-3311
- **Mailing address fax:** (801) 942-5955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 06/16/2008