Provider Demographics
NPI:1235264987
Name:SOUTHERN UTAH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SOUTHERN UTAH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:435-652-9188
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-652-9188
Mailing Address - Fax:435-652-9277
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-652-9188
Practice Address - Fax:435-652-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherTAX ID
UT=========OtherTAX ID