Healthcare Provider Details

I. General information

NPI: 1265363360
Provider Name (Legal Business Name): PATTI RUSHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S HIGHLAND DR
HOLLADAY UT
84117-5108
US

IV. Provider business mailing address

5038 S SANDPIPER DR APT 514
HOLLADAY UT
84117-4704
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-1892
  • Fax:
Mailing address:
  • Phone: 801-941-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14287995-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: