Sports & Orthopedic Physical Therapy of Kaysville LC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPORTS & ORTHOPEDIC PHYSICAL THERAPY OF KAYSVILLE LC

Practice address

1188 Sportsplex Dr
Ste. 101
Kaysville, UT 84037-9591

Phone

(801) 547-1155

Fax

(801) 547-1173

NPI assigned

Aug 15, 2006

Organization subpart

Yes

Parent organization

MOUNTAIN LAND REHABILITATION INCAs reported in NPPES

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

Authorized official

Name

Mr. Mark Anderson, PT

Title

President

Phone

(801) 942-3311

Specialties & licenses 2

Addresses

Part of

Mountain Land Rehabilit

Locations

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1790898930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 711185",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841711185",
            "telephone_number": "801-942-3311",
            "fax_number": "801-942-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1188 SPORTSPLEX DR",
            "address_2": "STE. 101",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840379591",
            "telephone_number": "801-547-1155",
            "fax_number": "801-547-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS & ORTHOPEDIC PHYSICAL THERAPY OF KAYSVILLE LC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN LAND REHABILITATION INC",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-942-3311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.