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Organization

FITNESS REHAB LLC

Active
Other names
Personal Fitness Systems Physical Therapy
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES CHARLES NACKOS DPT (OWNER)
(801) 375-6500
Entity
Organization

Contact information

Practice address
3089 N CANYON RD, PROVO, UT 84604-3920
(801) 375-6500
(801) 375-6505
Mailing address
PO BOX 307, BOUNTIFUL, UT 84011-0307
(888) 700-6907
(801) 294-6917

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5133156-2401
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
51331562400001
BLUE CROSS BLUE SHIELD
UT
Enumeration date
11/16/2006
Last updated
11/14/2007
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