Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Independence Rehab, LLC

Organization Physical Therapist · NPI 1063781813

Independence Rehab, LLC is a Physical Therapist in Provo, Utah. Registered with an NPI since 2011.

In the registry since
2011
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5314 N River Run Dr Ste 140
Provo, UT 84604-7706
Phone: (801) 426-4905
Fax: (801) 426-4953
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X
Occupational Therapist Taxonomy 225X00000X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1063781813
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Chad Fullmer — Vice President · (801) 494-0486
NPI enumeratedDecember 23, 2011
Last updated in NPPESMarch 24, 2026
Certification dateMarch 24, 2026
Mailing address5314 N River Run Dr Ste 140, Provo, UT 84604-7706

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