Provider Demographics
NPI:1720023450
Name:CENTRAL UTAH PHYSICAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:CENTRAL UTAH PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-896-6653
Mailing Address - Street 1:80 E 1000 N STE A
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1850
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:435-896-6662
Practice Address - Street 1:80 E 1000 N
Practice Address - Street 2:SUITE A
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1850
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:435-896-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
UT108532-2401332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty