Bear Lake Physical and Sports Therapy PC
Organization Active NPI Physical Therapist · Randolph, UT
NPI 1609085885 · NPPES record last updated Aug 13, 2025
Key facts
- NPI
- 1609085885
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 351974-2401 (UT)
- Legal business name
- BEAR LAKE PHYSICAL AND SPORTS THERAPY PC
- Practice address
- 35 South Main
Randolph, UT 84064 - Phone
- (435) 793-7000
- Fax
- (435) 946-9777
- NPI assigned
- May 22, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- BEAR LAKE PHYSICAL AND SPORTS THERAPY PC
Authorized official
- Name
- Ruthann Jarman
- Title
- Director
- Phone
- (833) 946-2777
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 2
Practitioners 2
-
Kam E Jarman, MPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121106000253 | UT | Part B Supplier - Clinic/Group Practice | 2264537687 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Garden City, UT; Randolph, UT |
National Provider Directory
- Tax ID family
- Bear Lake Phys Sprts Thrpy
- Part of
- Bear Lake Phys Sprts Thrpy
Locations
710 N 4th St
Montpelier, ID 83254
Phone (208) 847-1342
680 N 4th St
Ste 5
Montpelier, ID 83254
Phone (208) 847-1342
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 351974-2401 | UT | Yes |
| Physical Therapy Clinic/Center | 261QP2000X |
Addresses
Primary practice location
35 South Main
Randolph, UT 84064
Mailing address
PO Box 276
Garden City, UT 84028-0276
Phone (833) 946-2777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 816 | Other | UT | RANDOLPH CITY LICENSE |
Other names
- Bear Lake Physical Therapy - Randolph
Other providers in Randolph, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.