Thomas Bezemer, PT
Individual provider Active NPI Physical Therapist · Park City, UT
NPI 1679628002 · NPPES record last updated Nov 30, 2017
Key facts
- NPI
- 1679628002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 49452432401 (UT)
- Practice address
- 7600 Glenwild Dr
Park City, UT 84098-5587 - Phone
- (435) 901-1139
- Fax
- (435) 940-9127
- NPI assigned
- Jan 24, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
7461 Brook Hollow Loop Rd
Park City, UT 84098-8262
Phone (435) 901-1139
7600 Glenwild Dr
Park City, UT 84098-5587
Phone (435) 901-1139
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100211000521 | UT | Practitioner - Physical Therapist in Private Practice | 5890838957 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49452432401 | UT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proform Athletics, LLC | Current |
Accepting new patients | |
| Alpine Sports Medicine LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 49452432401 | UT | Yes |
Addresses
Primary practice location
7600 Glenwild Dr
Park City, UT 84098-5587
Mailing address
7461 Brook Hollow Loop Rd
Park City, UT 84098-8262
Phone (435) 901-1139
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 280669988016 | Medicaid | UT |
Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2017. 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.