Pure Performance Rehab

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PURE PERFORMANCE REHAB

Practice address

2295 S 2000 E Unit C
Millcreek, UT 84106-4138

Phone

(541) 490-4450

NPI assigned

Feb 8, 2021

Last updated

Feb 8, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

12066486-0162As reported in NPPES

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

Authorized official

Name

Audrey Jean Mallon, DPTNPI 1215420724

Title

Co-Business Owner

Phone

(541) 490-4450

Specialties & licenses 1

Addresses

Part of

Pure Performance Rehab

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Audrey Jean Mallon, DPT

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1215420724
  NPD Authorized official

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

{
    "created_epoch": "1612742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1962094219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E WHITLOCK AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153224",
            "telephone_number": "541-490-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2295 S 2000 E UNIT C",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841064138",
            "telephone_number": "541-490-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE PERFORMANCE REHAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "12066486-0162",
        "enumeration_date": "2021-02-08",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "MALLON",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CO-BUSINESS OWNER",
        "authorized_official_telephone_number": "541-490-4450",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Millcreek, UT
• Providers in Millcreek, UT by specialty
• Physical Therapy Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.