NPIMap

Organization Active NPI

Independence Rehab, LLC

  • Physical Therapist
  • Provo, UT
National Provider Identifier
1063781813
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
INDEPENDENCE REHAB, LLC
Practice address
5314 N River Run Dr Ste 140
Provo, UT 84604-7706
Phone
(801) 426-4905
Fax
(801) 426-4953
NPI assigned
Dec 23, 2011
Last updated
Mar 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Authorized official

Name
Chad FullmerNPI 1285760033
Title
Vice President
Phone
(801) 494-0486

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

5314 N River Run Dr Ste 140
Provo, UT 84604-7706

Mailing address

5314 N River Run Dr Ste 140
Provo, UT 84604-7706
Phone (801) 426-4905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, WA, AZ, NE, OR, WY, CO7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20120911000750 UT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143478453 Receives reassigned benefits from 6 practitioners
Practice locations: Sandy, UT; West Valley City, UT; Spanish Fork, UT; Salt Lake City, UT; Provo, UT; Ogden, UT; Midvale, UT
O20120924000501 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143478453 Receives reassigned benefits from 4 practitioners
Practice locations: Tacoma, WA; Shelton, WA; Seattle, WA; Normandy Park, WA; Kent, WA; Bellevue, WA
O20120924000778 AZ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143478453 Receives reassigned benefits from 5 practitioners
Practice locations: Tucson, AZ; Scottsdale, AZ; Oro Valley, AZ
O20210916002952 NE Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143478453 Receives reassigned benefits from 7 practitioners
Practice locations: Scottsbluff, NE
O20240227004659 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143478453 Receives reassigned benefits from 6 practitioners
Practice locations: Portland, OR; Springfield, OR
O20250530002483 WY Part B Supplier - Clinic/Group Practice 0143478453 Receives reassigned benefits from 3 practitioners
Practice locations: Sheridan, WY
O20260428000781 CO Part B Supplier - Clinic/Group Practice 0143478453 Practice locations: Westminster, CO

National Provider Directory

National Provider Directory

Locations

2520 S Redwood Rd
West Valley City, UT 84119
Phone (801) 972-1050

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1324598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774310400000",
    "number": "1063781813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5314 N RIVER RUN DR STE 140",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846047706",
            "telephone_number": "801-426-4905",
            "fax_number": "801-426-4953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5314 N RIVER RUN DR STE 140",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846047706",
            "telephone_number": "801-426-4905",
            "fax_number": "801-426-4953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-23",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "801-494-0486"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; 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.