Provider Demographics
NPI:1932363082
Name:TRUMAN & MOORE THERAPY
Entity Type:Organization
Organization Name:TRUMAN & MOORE THERAPY
Other - Org Name:ENTERPRISE VALLEY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-878-2722
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-0549
Mailing Address - Country:US
Mailing Address - Phone:775-726-3117
Mailing Address - Fax:775-726-3118
Practice Address - Street 1:660 E MAIN ST
Practice Address - Street 2:BLDG B
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725-0549
Practice Address - Country:US
Practice Address - Phone:435-878-2722
Practice Address - Fax:435-878-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7043969-2401225100000X
6333240001 PTAN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00669998OtherRAIL ROAD MEDICARE PTAN
UT6333240001Medicare NSC
UTP00669998OtherRAIL ROAD MEDICARE PTAN