Provider Demographics
NPI:1477705010
Name:SOUTH MOUNTAIN PT & REHABILITATION
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN PT & REHABILITATION
Other - Org Name:SOUTH MOUNTAIN PHYSICAL THERAPY AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-523-6376
Mailing Address - Street 1:6770 SOUTH 900 EAST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1753
Mailing Address - Country:US
Mailing Address - Phone:801-523-8242
Mailing Address - Fax:801-523-8242
Practice Address - Street 1:6770 SOUTH 900 EAST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1753
Practice Address - Country:US
Practice Address - Phone:801-523-8242
Practice Address - Fax:801-523-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323505-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy