Provider Demographics
NPI:1003943630
Name:SOUTHWEST NEUROLOGICAL REHABILITATION CENTER
Entity type:Organization
Organization Name:SOUTHWEST NEUROLOGICAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-5194
Mailing Address - Street 1:301 N 200 E
Mailing Address - Street 2:3E
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3010
Mailing Address - Country:US
Mailing Address - Phone:435-628-5194
Mailing Address - Fax:
Practice Address - Street 1:301 N 200 E
Practice Address - Street 2:3E
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3010
Practice Address - Country:US
Practice Address - Phone:435-628-5194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty