Provider Demographics
NPI:1144579616
Name:INTERMOUNTAIN HEALTHCARE
Entity Type:Organization
Organization Name:INTERMOUNTAIN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:435-671-0345
Mailing Address - Street 1:5572 WEST SLATE CANYON DRIVE
Mailing Address - Street 2:B-101
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081
Mailing Address - Country:US
Mailing Address - Phone:435-671-0345
Mailing Address - Fax:
Practice Address - Street 1:5572 WEST SLATE CANYON DRIVE
Practice Address - Street 2:APT B-101
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081
Practice Address - Country:US
Practice Address - Phone:435-671-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8334273-2401282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital