Provider Demographics
NPI:1144704065
Name:GREATER ST GEORGE PHYSICAL THERAPY AND WELLNESS, INC.
Entity type:Organization
Organization Name:GREATER ST GEORGE PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENOLERAO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-429-6887
Mailing Address - Street 1:2053 W 1820 N
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4856
Mailing Address - Country:US
Mailing Address - Phone:435-429-6887
Mailing Address - Fax:435-429-2838
Practice Address - Street 1:616 S RIVER RD STE 230
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2154
Practice Address - Country:US
Practice Address - Phone:435-429-6887
Practice Address - Fax:435-429-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy