Provider Demographics
NPI:1730724808
Name:VALLEY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:VALLEY PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-745-3200
Mailing Address - Street 1:1421 N 7275 E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9615
Mailing Address - Country:US
Mailing Address - Phone:801-920-9944
Mailing Address - Fax:801-745-6115
Practice Address - Street 1:5460 E 2200 N STE 3
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:UT
Practice Address - Zip Code:84310-9105
Practice Address - Country:US
Practice Address - Phone:801-745-3200
Practice Address - Fax:801-745-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy