Provider Demographics
NPI:1093966509
Name:SUNDANCE PHYSICAL THERAPY FARR WEST
Entity Type:Organization
Organization Name:SUNDANCE PHYSICAL THERAPY FARR WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-731-5421
Mailing Address - Street 1:2850 N 2000 W STE 204
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9230
Mailing Address - Country:US
Mailing Address - Phone:801-731-5421
Mailing Address - Fax:801-732-0303
Practice Address - Street 1:2850 N 2000 W STE 204
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404
Practice Address - Country:US
Practice Address - Phone:801-731-5421
Practice Address - Fax:801-732-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty