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Organization
PACK PHYSICAL THERAPY, INC.
Active
Organization
PACK PHYSICAL THERAPY, INC.
Active
Other names
ImPackt Physical Therapy and Sports Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRODIE JAMES PACK MPT (PRESIDENT/PHYSICAL THERAPIST)
(801) 260-3100
Entity
Organization
Contact information
Practice address
11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
(949) 350-6370
Mailing address
11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
(801) 260-3100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
NULL
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
NULL
2251X0800X
Orthopedic Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2774652-2401
UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
UT
Enumeration date
03/02/2012
Last updated
01/21/2025
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