Independence Rehab, LLC

NPI #1063781813 in Provo, Utah

Provider Information

NPI Number: 1063781813
Entity Type: Organization
Organization Name: Independence Rehab, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Dec 23, 2011
Last Updated: Dec 23, 2011

Practice Location

Address: 5314 RIVER RUN DR
Address 2: SUITE 140
City: Provo
State: Utah
ZIP Code: 84604-5691
Phone: (801) 494-0486

Authorized Official

Name: CHAD FULLMER
Title: VICE PRESIDENT
Phone: (801) 494-0486

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Speech-Language Pathologist	235Z00000X
Physical Therapist	225100000X	Primary

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