NPIMap

Organization Active NPI

Performance West Physical Therapy

  • Physical Therapist
  • Bountiful, UT
National Provider Identifier
1720148240
Registry record updated Nov 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
200631198 Issued in UT
Legal business name
PERFORMANCE WEST PHYSICAL THERAPY
Practice address
1551 Renaissance Towne Dr
Ste 350
Bountiful, UT 84010-7667
Phone
(801) 295-3553
Fax
(801) 295-3599
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2012

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

Authorized official

Name
Amy Busby
Title
Office Manager
Phone
(801) 295-3553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 200631198 UT Primary

Addresses

Primary practice location

1551 Renaissance Towne Dr
Ste 350
Bountiful, UT 84010-7667

Mailing address

1551 Renaissance Towne Dr
Ste 350
Bountiful, UT 84010-7667
Phone (801) 295-3553

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041129000296 UT Part B Supplier - Clinic/Group Practice 4789649047 Receives reassigned benefits from 12 practitioners
Practice locations: Bountiful, UT; Clearfield, UT; Farmington, UT; Kaysville, UT; West Point, UT

National Provider Directory

National Provider Directory

Locations

185 S 400 E
Ste 207
Bountiful, UT 84010
Phone (801) 797-9105

1551 Renaissance Towne Dr
Ste 350
Bountiful, UT 84010
Phone (801) 295-3553

1551 Renaissance Towne Dr
Bountiful, UT 84010
Phone (801) 295-5581

185 S 400 E
Ste 102
Bountiful, UT 84010

475 N 300 W
Ste 10
Kaysville, UT 84037
Phone (385) 209-2928

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353024000000",
    "number": "1720148240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "STE 350",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-3553",
            "fax_number": "801-295-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "STE 350",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-3553",
            "fax_number": "801-295-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE WEST PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-11-16",
        "status": "A",
        "authorized_official_last_name": "BUSBY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-295-3553"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "200631198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; 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.