# BEAR LAKE PHYSICAL AND SPORTS THERAPY PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BEAR LAKE PHYSICAL AND SPORTS THERAPY PC
- **Other names:** Bear Lake Physical Therapy - Randolph
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609085885
- **Legal business name:** BEAR LAKE PHYSICAL AND SPORTS THERAPY PC
- **Authorized official:** RUTHANN JARMAN (DIRECTOR)
- **Authorized official phone:** (833) 946-2777

## Contact information

- **Practice address:** 35 SOUTH MAIN, RANDOLPH, UT 84064
- **Practice address phone:** (435) 793-7000
- **Practice address fax:** (435) 946-9777
- **Mailing address:** PO BOX 276, GARDEN CITY, UT 84028-0276
- **Mailing address phone:** (833) 946-2777
- **Mailing address fax:** (354) 363-3146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 351974-2401 | UT | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 08/13/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 816 | RANDOLPH CITY LICENSE | UT |