Provider Demographics
NPI:1720133507
Name:LAYTON PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:LAYTON PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERBS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-728-4624
Mailing Address - Street 1:1868 N. 1200 W.
Mailing Address - Street 2:STE #A
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1937
Mailing Address - Country:US
Mailing Address - Phone:801-728-4624
Mailing Address - Fax:801-776-3087
Practice Address - Street 1:1868 N. 1200 W.
Practice Address - Street 2:STE #A
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1937
Practice Address - Country:US
Practice Address - Phone:801-728-4624
Practice Address - Fax:801-776-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274721-2401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528132106010Medicaid
UT000057903OtherMEDICARE PTAN