Provider Demographics
NPI:1003186669
Name:THE ATHLETE WITHIN
Entity Type:Organization
Organization Name:THE ATHLETE WITHIN
Other - Org Name:THE ATHLETE WITHIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-512-3647
Mailing Address - Street 1:8541 LITTLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6303
Mailing Address - Country:US
Mailing Address - Phone:801-512-3647
Mailing Address - Fax:435-336-4463
Practice Address - Street 1:989 E 900 S
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-1473
Practice Address - Country:US
Practice Address - Phone:801-512-3647
Practice Address - Fax:435-336-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7014647-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty