Vernon R Malan, PT
Individual provider Active NPI Physical Therapist · Perry, UT
NPI 1114110079 · NPPES record last updated Aug 23, 2007
Key facts
- NPI
- 1114110079
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 4974591-2401 (UT)
- Practice address
- 1950 S Highway 89
Perry, UT 84302-4119 - Phone
- (435) 723-1902
- Fax
- (435) 723-1908
- NPI assigned
- Aug 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Utah School of Medicine, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gateway Physical Therapy and Sports Rehab
Practice addresses (Care Compare)
169 N Gateway Dr
Suite 160
Providence, UT 84332-9882
Phone (435) 799-3111
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200128000813 | UT | Practitioner - Physical Therapist in Private Practice | 7810322591 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4974591-2401 | UT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Physical Therapy and Sports Rehab | Physical Therapist | Current |
Accepting new patients |
| Elite PT and Sports Rehab | Physical Therapist | Current |
Accepting new patients |
Locations
1041 S Medical Dr
Ste 101
Brigham City, UT 84302
Phone (435) 216-7790
169 N Gateway Dr
Ste 160
Providence, UT 84332
Phone (435) 770-8865
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4974591-2401 | UT | Yes |
Addresses
Primary practice location
1950 S Highway 89
Perry, UT 84302-4119
Mailing address
2380 N 400 E
Logan, UT 84341-1749
Phone (435) 713-9700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D4976 | Medicaid | UT |
Other providers in Perry, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.