Individual provider Active NPI

Jeanne Ann Korn, MPT

  • Physical Therapist
  • Salt Lake City, UT
National Provider Identifier
1063554269
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
53755942401 Issued in UT
Practice address
1952 E 7000 S
Suite 100
Salt Lake City, UT 84121
Phone
(801) 942-3311
Fax
(801) 942-5955
NPI assigned
Feb 13, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 53755942401 UT Primary

Addresses

Primary practice location

1952 E 7000 S
Suite 100
Salt Lake City, UT 84121

Mailing address

PO Box 711185
Salt Lake City, UT 84171
Phone (801) 942-3311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53755942401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Excel Orthopedic Physical Therapy, Inc. Physical Therapist CurrentSince Apr 1, 2001 Accepting new patients
Vail Physical Therapy & Sports Rehab. Physical Therapist Past Accepting new patients
Three Forks Physical Therapy, Inc. PastSince Aug 2, 2020 Accepting new patients
Excel Orthopedic Physical Therapy Limited Partnership Physical Therapist PastSince Jul 3, 2022 Accepting new patients

Locations

1125 W Kagy Blvd
Ste 101A
Bozeman, MT 59715
Phone (406) 556-0562

220 Wooden Shoe Ln
Ste C
Manhattan, MT 59741
Phone (406) 284-4262

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063554269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 711185",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84171",
            "telephone_number": "801-942-3311",
            "fax_number": "801-942-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 E 7000 S",
            "address_2": "SUITE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-942-3311",
            "fax_number": "801-942-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORN",
        "first_name": "JEANNE",
        "middle_name": "ANN",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "53755942401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.