Provider Demographics
NPI:1780007153
Name:PHYSICAL THERAPY EXPRESS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAKLIDES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:801-272-1522
Mailing Address - Street 1:2225 E MURRAY HOLLADAY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5382
Mailing Address - Country:US
Mailing Address - Phone:801-272-1522
Mailing Address - Fax:
Practice Address - Street 1:2225 E MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5382
Practice Address - Country:US
Practice Address - Phone:801-272-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78106132402261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy