# AVISTA PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1558943035
- **Authorized official:** JONATHAN DAX GERBER DPT (PHYSICAL THERAPIST/OWNER)
- **Authorized official phone:** (509) 818-9989

## Contact information

- **Practice address:** 3460 S REDWOOD RD STE 3, WEST VALLEY CITY, UT 84119-3400
- **Practice address phone:** (509) 818-9989
- **Mailing address:** 521 N 1030 E, PLEASANT GROVE, UT 84062-4534
- **Mailing address phone:** (509) 818-9989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |

## Other

- **Enumeration date:** 04/24/2021
- **Last updated:** 05/28/2021