Provider Demographics
NPI:1215260096
Name:UINTA PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:UINTA PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BRINKERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-783-8068
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-2400
Mailing Address - Country:US
Mailing Address - Phone:307-362-4336
Mailing Address - Fax:307-362-4339
Practice Address - Street 1:170 YELLOW CREEK RD
Practice Address - Street 2:SUITE D
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5200
Practice Address - Country:US
Practice Address - Phone:307-783-8068
Practice Address - Fax:307-783-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty