SPORTSMED PHYSICAL THERAPY OF BOUNTIFUL A PROFESSIONAL CORP (NPI# 1215119870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215119870 |
| Entity Type | Organization |
| Organization Name | SPORTSMED PHYSICAL THERAPY OF BOUNTIFUL A PROFESSIONAL CORP |
| Practice Address |
1551 Renaissance Twn Dr Ste 420 Bountiful UT 84010 |
| Mailing Address |
1551 Renaissance Twn Dr Ste 420 Bountiful UT 84010-7667 |
| Practice Telephone | 8012958999 |
| Practice Fax Number | 8012924168 |
| Mailing Telephone | 8012958999 |
| Mailing Fax Number | 8012924168 |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2018-05-18 |
| Authorized Official Name | MR. ROBERT A HAWKES (OWNER) |
| Authorized Official Telephone | 8012958999 |
| Authorized Official Credential | MSPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
UT | Ambulatory Health Care Facilities |
| Street Address |
1551 RENAISSANCE TWN DR STE 420 |
| City | BOUNTIFUL |
| State | UT |
| Zip Code | 84010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225699192 | Jessyca K Willie | Behavior Technician | 415 S. Medical Drive Suite D101, Bountiful, UT 84010 | 2019-06-21 |
| 1336634344 | Shanna Joy Jaggers | Social Worker | 2333 S 200 E, Bountiful, UT 84010 | 2018-06-22 |
| 1447773171 | Live Life Alarms | Emergency Response System Companies | 640 South 500 West, Bountiful, UT 84010 | 2017-07-25 |
| 1902328842 | Hailey Embley | Behavior Technician | 415 Medical Drive D 101, Bountiful, UT 84010 | 2017-07-12 |
| 1508318031 | Beverly Nielsen | Psychologist | 1001 Lakeview Drive, Bountiful, UT 84010 | 2016-11-01 |
| 1295287720 | Samantha Oslund | Speech-Language Pathologist | 415 Medical Dr Ste B102, Bountiful, UT 84010 | 2016-11-01 |
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1629464706 | Shane James | Speech-Language Pathologist | 425 Medical Dr Ste 122, Bountiful, UT 84010 | 2015-04-15 |
| 1891186102 | Kenton Francis | Social Worker | 1355 North Main Street #1, Bountiful, UT 84010 | 2015-02-09 |
| 1205233855 | Modern Dental Professionals - Utah, PC | Dentist | 24 S. 500 West, #a, Bountiful, UT 84010 | 2014-11-25 |
| Find all providers in zip 84010 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
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|---|---|---|---|---|
| 1396344198 | Shannon Ballinger | Clinic/Center | 1470 400 W, Salt Lake City, UT 84115 | 2020-10-22 |
| 1487261707 | Precision Jointcare LLC | Clinic/Center | 12523 S Creek Meadow Rd Ste 109, Riverton, UT 84065-7299 | 2020-09-30 |
| 1184231664 | Mountain Strong Spine and Performance | Clinic/Center | 1478 N 4925 W, Plain City, UT 84404-8300 | 2020-09-28 |
| 1881215085 | Move Well Age Well, LLC | Clinic/Center | 2223 S Highland Dr Ste E6-256, Salt Lake City, UT 84106-3672 | 2020-04-29 |
| 1215557434 | Basin Therapy LLC | Clinic/Center | 101 E 1875 S, Roosevelt, UT 84066-3828 | 2020-04-17 |
| 1780222893 | Well Being Pelvic Physical Therapy | Clinic/Center | 111 E 5600 S Ste 222, Murray, UT 84107-8164 | 2019-12-19 |
| 1265094619 | Recalibrate Physical Therapy | Clinic/Center | 3450 S 400 E, Salt Lake City, UT 84115-4604 | 2019-07-06 |
| 1598229155 | Neurorev Pllc | Clinic/Center | 520 N Market Place Dr Ste 200, Centerville, UT 84014-4904 | 2019-01-29 |
| 1104395821 | Color Country Physical Therapy LLC | Clinic/Center | 450 E Clinic Way, Ste B, Parowan, UT 84761 | 2018-11-26 |
| 1629556055 | Advanced Balance and Physical Therapy LLC | Clinic/Center | 856 Sage Dr Ste 301b, Cedar City, UT 84720 | 2018-07-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.