Provider Demographics
NPI:1871188680
Name:STAR PHYSICAL THERAPY & INJURY REHAB
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY & INJURY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-849-1029
Mailing Address - Street 1:392 E 12300 S STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8043
Mailing Address - Country:US
Mailing Address - Phone:801-849-1029
Mailing Address - Fax:801-890-0513
Practice Address - Street 1:392 E 12300 S STE C
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8043
Practice Address - Country:US
Practice Address - Phone:801-849-1029
Practice Address - Fax:801-890-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty