Provider Demographics
NPI:1386496941
Name:PHENIX PELVIC HEALTH
Entity type:Organization
Organization Name:PHENIX PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBANK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-799-7559
Mailing Address - Street 1:1141 E MOUNTAIN VISTA PL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3198
Mailing Address - Country:US
Mailing Address - Phone:435-799-7559
Mailing Address - Fax:
Practice Address - Street 1:2351 S RIVER RD STE 2
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8749
Practice Address - Country:US
Practice Address - Phone:435-215-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty