# INDEPENDENCE REHAB

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

## Provider details

- **NPI number:** 1407982630
- **Authorized official:** CHAD B. FULLMER (VICE PRESIDENT)
- **Authorized official phone:** (801) 635-6602

## Contact information

- **Practice address:** 1430 E 4500 S, SALT LAKE CITY, UT 84117-4208
- **Practice address phone:** (801) 426-4905
- **Practice address fax:** (801) 426-4953
- **Mailing address:** 797 E 640 N, LINDON, UT 84042-1647
- **Mailing address phone:** (801) 426-4905
- **Mailing address fax:** (801) 426-4953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 12/23/2011