1912936865 NPI number — REHAB MEDICAL OF SALT LAKE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912936865 NPI number — REHAB MEDICAL OF SALT LAKE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB MEDICAL OF SALT LAKE, 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:
6
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:
1912936865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 PRIORITY WAY SOUTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-436-6178
Provider Business Mailing Address Fax Number:
855-671-9194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3690 S 500 W
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-713-4187
Provider Business Practice Location Address Fax Number:
801-713-0517
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGINLEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-813-0205

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  000214 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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