Provider Demographics
NPI:1295163863
Name:NORTHPOINTE REHAB
Entity type:Organization
Organization Name:NORTHPOINTE REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-871-5228
Mailing Address - Street 1:397 N WILLOW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3091
Mailing Address - Country:US
Mailing Address - Phone:801-341-9712
Mailing Address - Fax:801-618-0920
Practice Address - Street 1:381 E 800 S STE 101
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6310
Practice Address - Country:US
Practice Address - Phone:801-871-5228
Practice Address - Fax:801-618-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5162373-2401261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U00007725Medicare UPIN