1073546040 NPI number — MR. RODNEY A MIYASAKI PT

Table of content: MR. RODNEY A MIYASAKI PT (NPI 1073546040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073546040 NPI number — MR. RODNEY A MIYASAKI PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIYASAKI
Provider First Name:
RODNEY
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073546040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5547 SO 4015 W
Provider Second Line Business Mailing Address:
WESTWOOD PHYSICAL THERAPY CLINIC #7
Provider Business Mailing Address City Name:
TAYLORSVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84129-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-967-6055
Provider Business Mailing Address Fax Number:
801-967-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5547 S 4015 W
Provider Second Line Business Practice Location Address:
#7
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84129-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-967-6055
Provider Business Practice Location Address Fax Number:
801-967-6934
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1079462401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44035 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 6400110 . This is a "UHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107000445102 . This is a "PHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 265950 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 42673 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: NO261 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190100500 . This is a "OWCP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 650013190 . This is a "RR MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000076206 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 3269413001 . This is a "CIGNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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