Provider Demographics
NPI:1467149690
Name:LODESTAR PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:LODESTAR PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:385-743-2757
Mailing Address - Street 1:1356 W WOODHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4314
Mailing Address - Country:US
Mailing Address - Phone:801-419-4502
Mailing Address - Fax:
Practice Address - Street 1:6070 S 1300 E STE 102
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-6723
Practice Address - Country:US
Practice Address - Phone:385-743-2757
Practice Address - Fax:385-444-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy