Organization
PROFORM ATHLETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS BEZEMER PT (OWNER/PHYSICAL THERAPIST)
(435) 901-1139
Entity
Organization
Contact information
Practice address
7600 GLENWILD DR, PARK CITY, UT 84098-5587
(435) 901-1139
(435) 940-9127
Mailing address
7461 BROOK HOLLOW LOOP RD, PARK CITY, UT 84098-8262
(435) 901-1139
(435) 940-9127
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
4945243-2401
UT
Other
Enumeration date
10/08/2009
Last updated
10/08/2009
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