Provider Demographics
NPI:1093188740
Name:CSC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CSC PHYSICAL THERAPY
Other - Org Name:CSC PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-427-2328
Mailing Address - Street 1:1940 N TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3287
Mailing Address - Country:US
Mailing Address - Phone:801-735-6759
Mailing Address - Fax:
Practice Address - Street 1:1292 N REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6631
Practice Address - Country:US
Practice Address - Phone:801-427-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty