Basic Information
| Provider Information | |||||||||
| NPI: | 1467470658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILLS PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 702128 | ||||||||
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| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841702128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017087867 | ||||||||
| FaxNumber: | 8016771510 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 W MAIN ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | EVERSON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609664810 | ||||||||
| FaxNumber: | 3609662884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | WORTLEY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8014175017 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009275 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.