1992980890 NPI number — NORTHERN PHYSICAL THERAPY SERVICES, LLC

Table of content: (NPI 1992980890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992980890 NPI number — NORTHERN PHYSICAL THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN PHYSICAL THERAPY SERVICES, 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:
1992980890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9070 W CHEYENNE AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129-8935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-818-5000
Provider Business Mailing Address Fax Number:
702-818-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 E 5800 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405-7139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-476-2000
Provider Business Practice Location Address Fax Number:
801-476-7000
Provider Enumeration Date:
01/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLASS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
ELDON
Authorized Official Title or Position:
CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
239-947-4184

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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