1427005511 NPI number — HOUSE CALL PHYSICAL THERAPY, LLC

Table of content: (NPI 1427005511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427005511 NPI number — HOUSE CALL PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSE CALL PHYSICAL THERAPY, LLC
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:
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:
1427005511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84335-0123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-757-6220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 N MAIN ST
Provider Second Line Business Practice Location Address:
BOX 123
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84335-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-757-6220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORSON
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
435-757-6220

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1221372401 , 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: 47664118104001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 59796P33G33 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 476641181033 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342464 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1646515 . This is a "COVENTRY" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 335326 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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