Provider Demographics
NPI:1659633691
Name:INTENSIVE PHYSICAL THERAPY INSTITUTE, LLC
Entity Type:Organization
Organization Name:INTENSIVE PHYSICAL THERAPY INSTITUTE, LLC
Other - Org Name:NEURO PATHWAYS PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:801-251-0257
Mailing Address - Street 1:4568 S HIGHLAND DR STE 180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4236
Mailing Address - Country:US
Mailing Address - Phone:801-251-0257
Mailing Address - Fax:801-251-0259
Practice Address - Street 1:4568 S HIGHLAND DR STE 180
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4236
Practice Address - Country:US
Practice Address - Phone:801-251-0257
Practice Address - Fax:801-251-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2775252401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy