Provider Demographics
NPI:1316721285
Name:THATCHER BROOK OUTPATIENT THERAPY LLC
Entity type:Organization
Organization Name:THATCHER BROOK OUTPATIENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:SASE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:801-614-5700
Mailing Address - Street 1:1795 CHELEMES WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6298
Mailing Address - Country:US
Mailing Address - Phone:801-614-5700
Mailing Address - Fax:801-614-5750
Practice Address - Street 1:1795 CHELEMES WAY
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6298
Practice Address - Country:US
Practice Address - Phone:801-614-5700
Practice Address - Fax:801-614-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech