Provider Demographics
NPI:1447309182
Name:SOUTHERN UTAH PHYSICAL THERAPY & REHABILITATION P.C.
Entity type:Organization
Organization Name:SOUTHERN UTAH PHYSICAL THERAPY & REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORSYTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-865-1902
Mailing Address - Street 1:1335 NORTHFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9390
Mailing Address - Country:US
Mailing Address - Phone:435-865-1902
Mailing Address - Fax:435-586-5176
Practice Address - Street 1:1335 NORTHFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9390
Practice Address - Country:US
Practice Address - Phone:435-865-1902
Practice Address - Fax:435-586-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055749Medicare PIN