NPIMap

Organization Active NPI

Professional Therapy and Rehabilitation LLC

  • Physical Therapist
  • Spanish Fork, UT
National Provider Identifier
1629259189
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL THERAPY AND REHABILITATION LLC
Practice address
77 S 400 W
Spanish Fork, UT 84660-2053
Phone
(801) 798-1626
Fax
(801) 798-1236
NPI assigned
Nov 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

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

Authorized official

Name
Edward H Budge, P.T.NPI 1417957291
Title
Owner/Physical Therapist
Phone
(801) 798-1626

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

77 S 400 W
Spanish Fork, UT 84660-2053

Mailing address

77 S 400 W
Spanish Fork, UT 84660-2053
Phone (801) 798-1626

Other identifiers 3

IdentifierTypeStateIssuer
QM0000076331OtherUTALTIUS HEALTH PLANS
PRA03496OtherUTMOLINA HEALTHCARE
695780OtherUTDMBA

Other names 1

  • Peak Physical Therapy and Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308001466 UT Part B Supplier - Clinic/Group Practice 3476441767 Receives reassigned benefits from 5 practitioners
Practice locations: Spanish Fork, UT

National Provider Directory

National Provider Directory

Locations

856 E 12300 S
Ste 7
Draper, UT 84020
Phone (801) 571-6600

856 E 12300 S
Draper, UT 84020
Phone (801) 571-6600

77 S 400 W
Spanish Fork, UT 84660
Phone (801) 798-1626

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501632000000",
    "number": "1629259189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 S 400 W",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846602053",
            "telephone_number": "801-798-1626",
            "fax_number": "801-798-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 S 400 W",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846602053",
            "telephone_number": "801-798-1626",
            "fax_number": "801-798-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL THERAPY AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2017-08-02",
        "status": "A",
        "authorized_official_last_name": "BUDGE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "801-798-1626",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS HEALTH PLANS",
            "identifier": "QM0000076331",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTHCARE",
            "identifier": "PRA03496",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "695780",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Physical Therapy and Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spanish Fork, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; 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.