Healthcare Provider Details

I. General information

NPI: 1144142845
Provider Name (Legal Business Name): ROGUE REFORM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 S 1100 E STE 201
SALT LAKE CITY UT
84105-3464
US

IV. Provider business mailing address

1790 S 1100 E STE 201
SALT LAKE CITY UT
84105-3464
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-3142
  • Fax:
Mailing address:
  • Phone: 801-923-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM SCHILTZ
Title or Position: OWNER
Credential: DPT
Phone: 801-923-3142