Organization
INDEPENDENCE REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD FULLMER (VICE PRESIDENT)
(801) 494-0486
Entity
Organization
Contact information
Practice address
5314 N RIVER RUN DR STE 140, PROVO, UT 84604-7706
(801) 426-4905
(801) 426-4953
Mailing address
5314 N RIVER RUN DR STE 140, PROVO, UT 84604-7706
(801) 426-4905
(801) 426-4953
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/23/2011
Last updated
03/24/2026
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