Provider Demographics
NPI:1629012240
Name:ROCK RUN PHYSICAL THERAPY AND REHAB SPECIALISTS,LLC
Entity Type:Organization
Organization Name:ROCK RUN PHYSICAL THERAPY AND REHAB SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:801-985-2700
Mailing Address - Street 1:5991 S 3500 W STE 300
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-6702
Mailing Address - Country:US
Mailing Address - Phone:801-985-2700
Mailing Address - Fax:801-985-2707
Practice Address - Street 1:5991 S 3500 W STE 300
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6702
Practice Address - Country:US
Practice Address - Phone:801-985-2700
Practice Address - Fax:801-985-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDG3878Medicare PIN
6031090001Medicare NSC
UT000059627Medicare ID - Type Unspecified