Provider Demographics
NPI:1225804487
Name:FIXIT PHYSIO - PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:FIXIT PHYSIO - PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:435-669-9191
Mailing Address - Street 1:13218 S WEATHERFORD LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5001
Mailing Address - Country:US
Mailing Address - Phone:435-669-9191
Mailing Address - Fax:
Practice Address - Street 1:13218 S WEATHERFORD LN
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5001
Practice Address - Country:US
Practice Address - Phone:435-669-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health