Healthcare Provider Details

I. General information

NPI: 1134056476
Provider Name (Legal Business Name): RANDY RODRIGUEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W 12TH ST
OGDEN UT
84404-5506
US

IV. Provider business mailing address

1429 N 250 W
LAYTON UT
84041-5860
US

V. Phone/Fax

Practice location:
  • Phone: 801-815-9296
  • Fax:
Mailing address:
  • Phone: 801-815-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: