Healthcare Provider Details

I. General information

NPI: 1861290256
Provider Name (Legal Business Name): AVIATION ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S WEST TEMPLE
SALT LAKE CITY UT
84115-1816
US

IV. Provider business mailing address

88 WASHINGTON AVE
CEDARHURST NY
11516-1902
US

V. Phone/Fax

Practice location:
  • Phone: 801-880-5775
  • Fax:
Mailing address:
  • Phone: 612-978-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REUVEN ROBERTS
Title or Position: CEO
Credential:
Phone: 612-978-4773