Organization
WASATCH PHYSICAL THERAPY & SPORTS MEDICINE AT PARK CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN S IVIE MPT (OWNER)
(435) 649-7335
Entity
Organization
Contact information
Practice address
597 PARKWAY DR, SUITE C, PARK CITY, UT 84098-5731
(435) 649-7335
(435) 649-7568
Mailing address
PO BOX 982287, PARK CITY, UT 84098-2287
(435) 649-7335
(435) 649-7568
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000057095
MEDICARE PTAN
UT
Enumeration date
07/30/2006
Last updated
05/17/2018
Update your record
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