Provider Demographics
NPI:1194022418
Name:KEVIN CHURCH PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:KEVIN CHURCH PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-957-1797
Mailing Address - Street 1:5255 S 4015 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4257
Mailing Address - Country:US
Mailing Address - Phone:801-957-1797
Mailing Address - Fax:801-957-1941
Practice Address - Street 1:5255 S 4015 W
Practice Address - Street 2:SUITE 205
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-4257
Practice Address - Country:US
Practice Address - Phone:801-957-1797
Practice Address - Fax:801-957-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy