Provider Demographics
NPI:1255440442
Name:PROFESSIONAL PHYSICAL THERAPY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, ATC
Authorized Official - Phone:801-373-1053
Mailing Address - Street 1:1325 S 800 E STE 215
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7767
Mailing Address - Country:US
Mailing Address - Phone:801-373-1053
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2251
Practice Address - Country:US
Practice Address - Phone:801-768-2723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
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