Organization
INDEPENDENCE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD B. FULLMER (VICE PRESIDENT)
(801) 635-6602
Entity
Organization
Contact information
Practice address
1430 E 4500 S, SALT LAKE CITY, UT 84117-4208
(801) 426-4905
(801) 426-4953
Mailing address
797 E 640 N, LINDON, UT 84042-1647
(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
02/23/2007
Last updated
12/23/2011
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