Provider Demographics
NPI:1316902307
Name:PRECISION PHYSICAL THERAPY INC,.
Entity type:Organization
Organization Name:PRECISION PHYSICAL THERAPY INC,.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY PRACTICE OWNER PT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER-GORMALLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-557-6733
Mailing Address - Street 1:3098 S HIGHLAND DR STE 350F
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3085
Mailing Address - Country:US
Mailing Address - Phone:801-557-6733
Mailing Address - Fax:
Practice Address - Street 1:3098 S HIGHLAND DR STE 350F
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3085
Practice Address - Country:US
Practice Address - Phone:801-557-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2710952401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT505985917001Medicaid
UT000057378OtherMEDICARE ID