Provider Demographics
NPI:1851324826
Name:WESTWOOD PHYSICAL THERAPY CLINIC
Entity Type:Organization
Organization Name:WESTWOOD PHYSICAL THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CO-OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-967-6055
Mailing Address - Street 1:5547 S 4015 W
Mailing Address - Street 2:#7
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4437
Mailing Address - Country:US
Mailing Address - Phone:801-967-6055
Mailing Address - Fax:801-967-6934
Practice Address - Street 1:5547 SO 4015 W
Practice Address - Street 2:#7
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-4429
Practice Address - Country:US
Practice Address - Phone:801-967-6055
Practice Address - Fax:801-967-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTW97642R6213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000076206OtherALTIUS
UT190100500OtherOWCR
UT999000139002Medicaid
UT1075070001Medicare NSC
UT000055380Medicare ID - Type Unspecified