# PACK PHYSICAL THERAPY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ImPackt Physical Therapy and Sports Recovery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336413798
- **Authorized official:** MR. BRODIE JAMES PACK MPT (PRESIDENT/PHYSICAL THERAPIST)
- **Authorized official phone:** (801) 260-3100

## Contact information

- **Practice address:** 11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
- **Practice address phone:** (949) 350-6370
- **Mailing address:** 11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
- **Mailing address phone:** (801) 260-3100

## Taxonomy

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

- **Enumeration date:** 03/02/2012
- **Last updated:** 01/21/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2774652-2401 | UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING | UT |