Provider Demographics
NPI:1497411854
Name:QOREPT LLC
Entity Type:Organization
Organization Name:QOREPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATENBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-669-2965
Mailing Address - Street 1:1261 S 820 E STE 110
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4004
Mailing Address - Country:US
Mailing Address - Phone:801-701-6699
Mailing Address - Fax:
Practice Address - Street 1:1261 S 820 E STE 110
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-4004
Practice Address - Country:US
Practice Address - Phone:801-701-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty