Provider Demographics
NPI:1881451284
Name:SOUTH VALLEY PHYSICAL THERAPY AND REHAB
Entity type:Organization
Organization Name:SOUTH VALLEY PHYSICAL THERAPY AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-455-5858
Mailing Address - Street 1:11488 S OPEN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-8790
Mailing Address - Country:US
Mailing Address - Phone:801-455-5858
Mailing Address - Fax:
Practice Address - Street 1:5734 W 13400 S STE 300
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6953
Practice Address - Country:US
Practice Address - Phone:801-828-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WW HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty