Provider Demographics
NPI:1518668110
Name:PERSEVERE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PERSEVERE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:435-557-1920
Mailing Address - Street 1:528 S 770 E
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1778
Mailing Address - Country:US
Mailing Address - Phone:435-557-1920
Mailing Address - Fax:
Practice Address - Street 1:528 S 770 E
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1778
Practice Address - Country:US
Practice Address - Phone:435-557-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy