Healthcare Provider Details

I. General information

NPI: 1902652787
Provider Name (Legal Business Name): ROSENBERG COOLEY METCALF LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 S 3000 E STE 200
SALT LAKE CITY UT
84121-3552
US

IV. Provider business mailing address

900 ROUND VALLEY DR STE 100
PARK CITY UT
84060-7552
US

V. Phone/Fax

Practice location:
  • Phone: 801-743-4500
  • Fax: 435-655-2388
Mailing address:
  • Phone: 435-655-6600
  • Fax: 435-655-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. GARRETT DAVIS
Title or Position: OWNER
Credential: MD
Phone: 435-655-6600