Provider Demographics
NPI:1568960037
Name:NORTHERN HOLDINGS
Entity Type:Organization
Organization Name:NORTHERN HOLDINGS
Other - Org Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPT/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:EREKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-281-1525
Mailing Address - Street 1:6321 S REDWOOD RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6321 S REDWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6799
Practice Address - Country:US
Practice Address - Phone:801-281-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty