Healthcare Provider Details

I. General information

NPI: 1851563084
Provider Name (Legal Business Name): DESERET THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MARKET PLACE DR STE 203
CENTERVILLE UT
84014-1708
US

IV. Provider business mailing address

500 N. MARKET PLACE DR. STE 203
CENTERVILLE UT
84014-1709
US

V. Phone/Fax

Practice location:
  • Phone: 801-296-5105
  • Fax: 801-382-1098
Mailing address:
  • Phone: 801-296-5105
  • Fax: 801-382-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON ROBERTSON
Title or Position: CEO
Credential:
Phone: 801-296-5105