Proform Athletics, LLC

Key facts

NPI

1689909772

Entity type

Organization (NPI type 2)

Primary specialty

Orthopedic Physical Therapist 2251X0800X

License

4945243-2401 (UT)

Legal business name

PROFORM ATHLETICS, LLC

Practice address

7600 Glenwild Dr
Park City, UT 84098-5587

Phone

(435) 901-1139

Fax

(435) 940-9127

NPI assigned

Oct 8, 2009

Organization subpart

No

Authorized official

Name

Mr. Thomas Bezemer, PT NPI 1679628002

Title

Owner/Physical Therapist

Phone

(435) 901-1139

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

• Thomas Bezemer, PT Physical Therapist · Park City, UT · NPI 1679628002
  Medicare reassignment NPD Authorized official UT

Medicare participation

Medicare fee-for-service enrollment

Enrolled in UT

Medicare enrollment records

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 8, 2009.

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254960000000",
    "number": "1689909772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7461 BROOK HOLLOW LOOP RD",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840988262",
            "telephone_number": "435-901-1139",
            "fax_number": "435-940-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 GLENWILD DR",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985587",
            "telephone_number": "435-901-1139",
            "fax_number": "435-940-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFORM ATHLETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-10-08",
        "status": "A",
        "authorized_official_last_name": "BEZEMER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "435-901-1139",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "4945243-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park City, UT

• Rebecca Ellen Price, LMFT
• Bertram Pride
• Jonathan Caleb Prior
• Adam Procino
• Karen Joan Procino, PT
• William Province III, MD
• Ashley Quadros, RDN
• David Quammen, MSED, ATC, CSCS
• Janalee Quilter
• Tracey F Radovan, PT

All providers in Park City, UT · Orthopedic Physical Therapist in Utah