Unknown Individual – Physical Therapist, NPI 1720067796

Physical Therapist

Unknown Individual is a healthcare provider. based in Salt lake city, Utah. specializing in Physical Therapist. They hold a License No. 2704752401 (UT). The NPI Number for Unknown Individual is 1720067796

Main info

Organization

Inactive

34 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1720067796

Phone

(801) 262-8486

Address

1160 E 3900 S

Deactivation Date

3 July 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8012628486

Graduation Year

1992 (34 years ago)

PAC ID

4284689589

Group Practice PAC ID

3173422730

Professional Enrollment ID

I20050321000197

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

1160, 3900 South, Millcreek, Salt Lake County, Utah, 84124, United States
#5000
SALT LAKE CITY, UT 841241275
Phone: (801) 262-8486
Fax: (801) 284-8699
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
97110	Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	567	54	$0
97530	Therapy procedure using functional activities	161	27	$0
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care	81	14	$0
97162	Evaluation for physical therapy, typically 30 minutes	44	42	$0

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Insurance plans in this area (ZIP 84124)

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Provider's Procedures

Unknown Individual performs procedures in Physical Therapist. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PHYSICAL THERAPY	UT	97001	Physical therapy evaluation	110	105

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3173422730View full group profile

Name	Specialty	State
DR. JEFFREY G RANDLE (MD)	Physical Medicine And Rehabilitation	UT
DR. BENJAMIN DAVID CURTIS (M.D.)	Orthopedic Surgery, Hand Surgery	UT
JARED TAKESHI AIDA (D.O.)	Physical Medicine And Rehabilitation, Sports Medicine	CA
DR. SCOTT ROMNEY MCKELL (DPM)	P O D I A T R Y	UT
ALEX ANDERSON BALL (PT, DPT)	-	UT
CRAIG HUGH MCQUEEN (M.D.)	-	UT
DR. BRUCE Y NEWTON (MD)	Physical Medicine And Rehabilitation	UT
DAVID EARL CURTIS (M.D.)	Orthopedic Surgery	UT
KYLER CLUFF (FNP)	Nurse Practitioner	UT
DR. BRENT A FELIX (MD)	Orthopedic Surgery	UT