Provider Demographics
NPI:1427005511
Name:HOUSE CALL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:HOUSE CALL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-757-6220
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-0123
Mailing Address - Country:US
Mailing Address - Phone:435-757-6220
Mailing Address - Fax:
Practice Address - Street 1:140 N MAIN ST
Practice Address - Street 2:BOX 123
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-1908
Practice Address - Country:US
Practice Address - Phone:435-757-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1221372401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47664118104001OtherBLUE CROSS BLUE SHIELD
UT59796P33G33OtherPEHP
UT476641181033Medicaid
UT342464OtherDMBA
UT1646515OtherCOVENTRY
UT335326OtherALTIUS
UT47664118104001OtherBLUE CROSS BLUE SHIELD
UT476641181033Medicaid