Provider Demographics
NPI:1790815173
Name:HAND & ORTHOPEDIC REHABILITATION SPECIALISTS PC
Entity Type:Organization
Organization Name:HAND & ORTHOPEDIC REHABILITATION SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,CHT
Authorized Official - Phone:801-261-3321
Mailing Address - Street 1:702 E SOUTH TEMPLE
Mailing Address - Street 2:102
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1204
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:702 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1204
Practice Address - Country:US
Practice Address - Phone:801-328-8535
Practice Address - Fax:801-261-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1108540001Medicare NSC
UT000055807Medicare PIN