Organization
ORTHOPAEDIC THERAPY AND SPORTS PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M TAYLOR (CREDENTIALING REP)
(801) 505-0821
Entity
Organization
Contact information
Practice address
1030 S MEDICAL DR, STE B, BRIGHAM CITY, UT 84302-0739
(435) 538-5111
(435) 723-9710
Mailing address
1030 S MEDICAL DR, STE B, BRIGHAM CITY, UT 84302-0739
(435) 538-5111
(435) 723-9710
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000075442
PTAN
UT
Enumeration date
05/25/2011
Last updated
01/26/2017
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