Provider Demographics
NPI:1538337837
Name:EMPOWERED REHAB LLC
Entity type:Organization
Organization Name:EMPOWERED REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JERAMIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-803-9800
Mailing Address - Street 1:4487 SEBAGO WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5690
Mailing Address - Country:US
Mailing Address - Phone:801-803-9800
Mailing Address - Fax:801-803-9801
Practice Address - Street 1:4487 SEBAGO WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5690
Practice Address - Country:US
Practice Address - Phone:801-803-9800
Practice Address - Fax:801-803-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5908308-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy