Provider Demographics
NPI:1265794333
Name:MVP SPORTS SCIENCE INSTITUTE INC
Entity type:Organization
Organization Name:MVP SPORTS SCIENCE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ABERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-244-1292
Mailing Address - Street 1:1826 COTTONWOOD CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7627
Mailing Address - Country:US
Mailing Address - Phone:801-244-1292
Mailing Address - Fax:801-273-7474
Practice Address - Street 1:1826 COTTONWOOD CLUB DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7627
Practice Address - Country:US
Practice Address - Phone:801-244-1292
Practice Address - Fax:801-273-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118791-2401225100000X
UT118804-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty