Provider Demographics
NPI:1184290348
Name:FORTIFY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:FORTIFY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:208-431-0211
Mailing Address - Street 1:2840 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5594
Mailing Address - Country:US
Mailing Address - Phone:208-431-0211
Mailing Address - Fax:435-355-3759
Practice Address - Street 1:792 S 3000 E STE 104
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1801
Practice Address - Country:US
Practice Address - Phone:208-431-0211
Practice Address - Fax:435-355-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy