1376754929 NPI number — PRECISION REHABILITATION PC

Table of content: (NPI 1376754929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376754929 NPI number — PRECISION REHABILITATION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION REHABILITATION PC
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:
PRECISION REHABILITATION PC
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:
1376754929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 745
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLANDING
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84511-0745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-678-3869
Provider Business Mailing Address Fax Number:
435-678-3769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 S 200 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANDING
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84511-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-678-3869
Provider Business Practice Location Address Fax Number:
435-678-3769
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
435-979-2742

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  327198-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 5009456-4201 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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