Provider Demographics
NPI:1306012513
Name:HIDDEN COVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:HIDDEN COVE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-915-1554
Mailing Address - Street 1:10543 S 2330 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2609
Mailing Address - Country:US
Mailing Address - Phone:801-254-1554
Mailing Address - Fax:
Practice Address - Street 1:10543 S 2330 W
Practice Address - Street 2:HIDDEN COVE PHYSICAL THERAPY INC
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2609
Practice Address - Country:US
Practice Address - Phone:801-254-1554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4306251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health