Independence Rehab, LLC
NPI 1063781813ActiveOrganization· Physical Therapist· Provo, UT
Physical Therapist in Provo, Utah, registered in NPPES in December 2011. The authorized official on file is Chad Fullmer, Vice President. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice and part b supplier - clinic/group practice.
Overview
| NPI | 1063781813 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 23, 2011 |
| Last updated in NPPES | Mar 24, 2026 |
| Certified by provider | Mar 24, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Occupational Therapist | 225X00000X | — | — |
| Speech-Language Pathologist | 235Z00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (AZ); Part B Supplier - Clinic/Group Practice (CO); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (NE); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (OR); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (UT); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (WA); Part B Supplier - Clinic/Group Practice (WY) |
|---|
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