Organization
PT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN STAVAST (OWNER)
(801) 899-3814
Entity
Organization
Contact information
Practice address
526 W CENTER ST STE N105, PLEASANT GROVE, UT 84062-3360
(801) 899-3814
Mailing address
648 E 220 N, AMERICAN FORK, UT 84003-2050
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/31/2024
Last updated
10/08/2024
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