Organization
PACK PHYSICAL THERAPY, INC.
Active
Other names
ImPackt Physical Therapy and Sports Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRODIE JAMES PACK MPT (PRESIDENT/PHYSICAL THERAPIST)
(801) 260-3100
Entity
Organization
Contact information
Practice address
11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
(949) 350-6370
Mailing address
11531 S DISTRICT DR STE 900, SOUTH JORDAN, UT 84095-5780
(801) 260-3100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2774652-2401
UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
UT
Enumeration date
03/02/2012
Last updated
01/21/2025
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