Provider Demographics
NPI:1417976499
Name:FORSYTH, TORI B (PT)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:B
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7792
Mailing Address - Country:US
Mailing Address - Phone:435-586-0064
Mailing Address - Fax:435-867-1243
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7792
Practice Address - Country:US
Practice Address - Phone:435-586-0064
Practice Address - Fax:435-867-1243
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121010-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107007312103OtherSELECT HEALTH
UT59793OtherPEHP
UTPRA03875OtherMOLINA
UTPRA03875OtherMOLINA