NPIMap

Organization Active NPI

KFDD Physical Therapy & Sports Medicine Clinic

  • Physical Therapist
  • Ogden, UT
National Provider Identifier
1013028505
Registry record updated Apr 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
115411-2401 Issued in UT
Legal business name
KFDD PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Practice address
2261 Kiesel Ave.
Suite #320
Ogden, UT 84401-1969
Phone
(801) 621-8835
Fax
(801) 528-5357
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Chris Holmgren Dahlberg, P.T.NPI 1366553208
Title
Corporation President, Business Own
Phone
(801) 621-8835

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 115411-2401 UT Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 114380-2401 UT
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X 115411-2401 UT
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X 114380-2401 UT

Addresses

Primary practice location

2261 Kiesel Ave.
Suite #320
Ogden, UT 84401-1969

Mailing address

2261 Kiesel Ave.
Suite #320
Ogden, UT 84401-1969
Phone (801) 621-8835

Other names 1

  • Sports Medicine Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000553 UT Part B Supplier - Clinic/Group Practice 5496702342 Receives reassigned benefits from 1 practitioner
Practice locations: Ogden, UT

National Provider Directory

National Provider Directory

Locations

2261 Kiesel Ave
Ste 320
Ogden, UT 84401
Phone (801) 621-8835

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334620800000",
    "number": "1013028505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2261 KIESEL AVE.",
            "address_2": "SUITE #320",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011969",
            "telephone_number": "801-621-8835",
            "fax_number": "801-528-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2261 KIESEL AVE.",
            "address_2": "SUITE #320",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011969",
            "telephone_number": "801-621-8835",
            "fax_number": "801-528-5357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KFDD PHYSICAL THERAPY & SPORTS MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-04-17",
        "status": "A",
        "authorized_official_last_name": "DAHLBERG",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "HOLMGREN",
        "authorized_official_title_or_position": "CORPORATION PRESIDENT, BUSINESS OWN",
        "authorized_official_telephone_number": "801-621-8835",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "115411-2401",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "114380-2401",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "115411-2401",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "114380-2401",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.