# WELLSPRING PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265513774
- **Authorized official:** KRISTA J CLARK P.T. (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (435) 657-0123

## Contact information

- **Practice address:** 210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
- **Practice address phone:** (435) 657-0123
- **Practice address fax:** (435) 657-0330
- **Mailing address:** 210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
- **Mailing address phone:** (435) 657-0123
- **Mailing address fax:** (435) 657-0330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 116187-2401 | UT | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 03/17/2018