Active NPI
Kirk W Newbold, PT
- Physical Therapist
- Orem, UT
National Provider Identifier
1104812098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4809421-2401
- Practice address
- 684 W 800 N
#110
Orem, UT 84057-3658 - Phone
- (801) 224-2250
- Fax
- (801) 224-2655
- NPI assigned
- Sep 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4809421-2401 | UT | Primary |
Addresses
Primary practice location
684 W 800 N
#110
Orem, UT 84057-3658
Mailing address
380 E 400 S
Springville, UT 84663-1958
Phone (801) 489-5669
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 48094212401001 | Other | UT | BCBS TRADITIONAL |
| 6400700 | Other | UT | UNITED HEALTHCARE |
| 77716 | Other | UT | PEHP |
| 1137576-005 | Other | UT | CIGNA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4809421-2401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187740800000",
"number": "1104812098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 E 400 S",
"city": "SPRINGVILLE",
"state": "UT",
"postal_code": "846631958",
"telephone_number": "801-489-5669",
"fax_number": "801-489-5783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "684 W 800 N",
"address_2": "#110",
"city": "OREM",
"state": "UT",
"postal_code": "840573658",
"telephone_number": "801-224-2250",
"fax_number": "801-224-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWBOLD",
"first_name": "KIRK",
"middle_name": "W",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-26",
"last_updated": "2007-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "4809421-2401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TRADITIONAL",
"identifier": "48094212401001",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "6400700",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "77716",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1137576-005",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.