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Organization
DELTA PHYSICAL THERAPY AND SPORTS
Active
Organization
DELTA PHYSICAL THERAPY AND SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. L HOWARD QUACKENBUSH II P.T. (PHYSICAL THERAPIST PRESIDENT)
(435) 864-2551
Entity
Organization
Contact information
Practice address
95 WHITE SAGE AVE, SUITE C, DELTA, UT 84624-5555
(435) 864-2551
(435) 864-3573
Mailing address
95 WHITE SAGE AVE, SUITE C, DELTA, UT 84624-5555
(435) 864-2551
(435) 864-3573
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
285712-2401
UT
225X00000X
Occupational Therapist
5530573-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669788725
—
UT
05
—
529299099026
—
UT
Enumeration date
06/03/2006
Last updated
09/12/2013
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