Provider Demographics
NPI:1194965665
Name:ALPINE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ALPINE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:801-216-4299
Mailing Address - Street 1:75 W MAIN STREET CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-5602
Mailing Address - Country:US
Mailing Address - Phone:801-216-4299
Mailing Address - Fax:801-216-4298
Practice Address - Street 1:75 W MAIN STREET CT STE 100
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-5602
Practice Address - Country:US
Practice Address - Phone:801-216-4299
Practice Address - Fax:801-216-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4777580-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy