Organization
WELLSPRING PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA J CLARK P.T. (OWNER/PHYSICAL THERAPIST)
(435) 657-0123
Entity
Organization
Contact information
Practice address
210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
(435) 657-0123
(435) 657-0330
Mailing address
210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
(435) 657-0123
(435) 657-0330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
116187-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11618724000001
BCBS
UT
05
—
5291725170001
—
UT
01
—
64-00532
UNITEDHEALTHCARE
UT
01
—
67054
PEHP
UT
Enumeration date
10/18/2006
Last updated
03/17/2018
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