Provider Demographics
NPI:1447035498
Name:FREEDOM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-619-5978
Mailing Address - Street 1:4704 S DUTCH HOLLOW LN # 805
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5895
Mailing Address - Country:US
Mailing Address - Phone:509-619-5978
Mailing Address - Fax:
Practice Address - Street 1:150 W 4800 S STE 30
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3700
Practice Address - Country:US
Practice Address - Phone:385-743-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty