Provider Demographics
NPI:1689627564
Name:WEBB PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:WEBB PHYSICAL THERAPY INC.
Other - Org Name:HORIZON BALANCE AND DIZZINESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-5777
Mailing Address - Street 1:1452 E RIDGELINE DR
Mailing Address - Street 2:#51
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4946
Mailing Address - Country:US
Mailing Address - Phone:801-479-5777
Mailing Address - Fax:801-479-7005
Practice Address - Street 1:1452 E RIDGELINE DR
Practice Address - Street 2:#51
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4946
Practice Address - Country:US
Practice Address - Phone:801-479-5777
Practice Address - Fax:801-479-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120650-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT527836568012Medicaid
UT52783656808001OtherBCBS TRAD. PROVIDER #
UTTPRA10491OtherMOLINA PROVIDER #
UT52783656808001OtherBCBS FED. PROVIDER #
UT577514OtherDMBA PROVIDER #