1124109921 NPI number — DRY CREEK PHYSICAL THERAPY & WELLNESS PLLC

Table of content: (NPI 1124109921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124109921 NPI number — DRY CREEK PHYSICAL THERAPY & WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRY CREEK PHYSICAL THERAPY & WELLNESS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRY CREEK PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1124109921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 RUNNING CREEK WAY
Provider Second Line Business Mailing Address:
BUILDING B SUITE 150
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-5563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-766-4244
Provider Business Mailing Address Fax Number:
801-766-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 RUNNING CREEK WAY
Provider Second Line Business Practice Location Address:
BUILDING B SUITE 150
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043-5563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-766-4244
Provider Business Practice Location Address Fax Number:
801-766-4245
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHANAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
801-766-4244

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3000209 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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