# DELTA PHYSICAL THERAPY AND SPORTS

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

## Provider details

- **NPI number:** 1801834700
- **Authorized official:** DR. L HOWARD QUACKENBUSH II P.T. (PHYSICAL THERAPIST PRESIDENT)
- **Authorized official phone:** (435) 864-2551

## Contact information

- **Practice address:** 95 WHITE SAGE AVE, SUITE C, DELTA, UT 84624-5555
- **Practice address phone:** (435) 864-2551
- **Practice address fax:** (435) 864-3573
- **Mailing address:** 95 WHITE SAGE AVE, SUITE C, DELTA, UT 84624-5555
- **Mailing address phone:** (435) 864-2551
- **Mailing address fax:** (435) 864-3573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 285712-2401 | UT | Yes |
| 225X00000X | Occupational Therapist | 5530573-4201 | UT | — |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 09/12/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1669788725 | — | UT |
| 05 | — | 529299099026 | — | UT |