Healthcare Provider Details

I. General information

NPI: 1255908984
Provider Name (Legal Business Name): ELIJAH PAUL ROGERS PT, DPT, TPI-2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 E 12200 S STE E
DRAPER UT
84020-9131
US

IV. Provider business mailing address

726 E 12200 S STE E
DRAPER UT
84020-9131
US

V. Phone/Fax

Practice location:
  • Phone: 385-237-4633
  • Fax: 801-761-6237
Mailing address:
  • Phone: 385-237-4633
  • Fax: 801-761-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12292236-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: