Provider Demographics
NPI:1831450113
Name:PHYSICAL THERAPY AND SPORTS
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELAP
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:801-869-1973
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6923
Mailing Address - Country:US
Mailing Address - Phone:801-869-1975
Mailing Address - Fax:801-869-1973
Practice Address - Street 1:6360 S 3000 E
Practice Address - Street 2:SUITE 210
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6923
Practice Address - Country:US
Practice Address - Phone:801-869-1975
Practice Address - Fax:801-869-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty