Provider Demographics
NPI:1477582633
Name:REGISTERED PHYSICAL THERAPISTS, INC.
Entity Type:Organization
Organization Name:REGISTERED PHYSICAL THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-572-0690
Mailing Address - Street 1:9720 S 1300 E
Mailing Address - Street 2:W200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3712
Mailing Address - Country:US
Mailing Address - Phone:801-572-0690
Mailing Address - Fax:801-572-0696
Practice Address - Street 1:9720 S 1300 E
Practice Address - Street 2:W200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3712
Practice Address - Country:US
Practice Address - Phone:801-572-0690
Practice Address - Fax:801-572-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0052924012261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055207Medicare ID - Type Unspecified