Individual provider Active NPI

Stuart Chase Sondrup, D.P.T.

  • Physical Therapist
  • Bountiful, UT
National Provider Identifier
1790066124
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
79252372401 Issued in UT
Practice address
1551 Renaissance Towne Dr
Ste 350
Bountiful, UT 84010-7667
Phone
(801) 295-3553
Fax
(801) 295-3599
NPI assigned
Aug 30, 2011
Last updated
Aug 30, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 79252372401 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
I20111202000190 UT Practitioner - Physical Therapist in Private Practice 6305011313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Performance West Physical TherapyGroup PAC ID 4789649047, 11 clinicians

Practice addresses (Care Compare)

1551 Renaissance Towne Dr
Suite 350
Bountiful, UT 84010-7674
Phone (801) 295-3553

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
79252372401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Performance West Physical Therapy Physical Therapist CurrentSince Jul 26, 2011 Accepting new patients

Locations

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

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

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1790066124",
    "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": {
        "last_name": "SONDRUP",
        "first_name": "STUART",
        "middle_name": "CHASE",
        "name_prefix": "Mr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "79252372401",
            "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 Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.