Provider Demographics
NPI:1811926538
Name:LEHI PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:LEHI PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-768-3105
Mailing Address - Street 1:41 E. 1140 N.
Mailing Address - Street 2:SUITE A
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045
Mailing Address - Country:US
Mailing Address - Phone:801-768-3105
Mailing Address - Fax:801-766-0188
Practice Address - Street 1:41 E. 1140 N.
Practice Address - Street 2:SUITE A
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045
Practice Address - Country:US
Practice Address - Phone:801-768-3105
Practice Address - Fax:801-766-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN005813001Medicare ID - Type Unspecified
UT1811926538Medicare PIN