Provider Demographics
NPI:1699811133
Name:FREEMAN PHYSICAL THERAPY GROUP INC
Entity Type:Organization
Organization Name:FREEMAN PHYSICAL THERAPY GROUP INC
Other - Org Name:KENNETH A FREEMAN DPT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-446-7171
Mailing Address - Street 1:3409 W 12600 S
Mailing Address - Street 2:#230
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7260
Mailing Address - Country:US
Mailing Address - Phone:801-446-7171
Mailing Address - Fax:801-446-7373
Practice Address - Street 1:3409 W 12600 SOUTH
Practice Address - Street 2:# 230
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-446-7171
Practice Address - Fax:801-446-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1219322401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005712901Medicare PIN
UT000057129Medicare PIN