NPIMap

Organization Active NPI

Canyon Sports Therapy Inc

  • Physical Therapist
  • Holladay, UT
National Provider Identifier
1083920052
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
121600-2401 Issued in UT
Legal business name
CANYON SPORTS THERAPY INC
Practice address
6069 Highland Dr
Holladay, UT 84121-1375
Phone
(801) 944-1209
Fax
(801) 274-1180
NPI assigned
Aug 27, 2010
Last updated
Sep 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

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

Authorized official

Name
Beatrice M Monteyne
Title
Cfo
Phone
(801) 243-0014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 121600-2401 UT Primary

Addresses

Primary practice location

6069 Highland Dr
Holladay, UT 84121-1375

Mailing address

PO Box 71403
Salt Lake City, UT 84171-0403
Phone (801) 944-1209

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101030000151 UT Part B Supplier - Clinic/Group Practice 2062606312 Receives reassigned benefits from 4 practitioners
Practice locations: Holladay, UT

National Provider Directory

National Provider Directory

Locations

6069 S Highland Dr
Holladay, UT 84121
Phone (801) 278-7444

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1083920052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71403",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841710403",
            "telephone_number": "801-944-1209",
            "fax_number": "801-274-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6069 HIGHLAND DR",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841211375",
            "telephone_number": "801-944-1209",
            "fax_number": "801-274-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON SPORTS THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-27",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "MONTEYNE",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "801-243-0014"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "121600-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holladay, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.