Provider Demographics
NPI:1356470009
Name:CENTRAL UTAH PHYSICAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:CENTRAL UTAH PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-896-6653
Mailing Address - Street 1:20 W 925 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-5500
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:435-896-6662
Practice Address - Street 1:20 W 925 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-5500
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:435-896-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6234806-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055197OtherMEDICARE PTAN
UT000055197Medicare PIN