# FITNESS REHAB LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Personal Fitness Systems Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427121607
- **Authorized official:** JAMES CHARLES NACKOS DPT (OWNER)
- **Authorized official phone:** (801) 375-6500

## Contact information

- **Practice address:** 3089 N CANYON RD, PROVO, UT 84604-3920
- **Practice address phone:** (801) 375-6500
- **Practice address fax:** (801) 375-6505
- **Mailing address:** PO BOX 307, BOUNTIFUL, UT 84011-0307
- **Mailing address phone:** (888) 700-6907
- **Mailing address fax:** (801) 294-6917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 5133156-2401 | UT | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 11/14/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 51331562400001 | BLUE CROSS BLUE SHIELD | UT |