Healthcare Provider Details

I. General information

NPI: 1518889435
Provider Name (Legal Business Name): SPENCER ROOS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10619 S JORDAN GTWY STE 205
SOUTH JORDAN UT
84095-3967
US

IV. Provider business mailing address

10619 S JORDAN GTWY STE 205
SOUTH JORDAN UT
84095-3967
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-0213
  • Fax:
Mailing address:
  • Phone: 801-264-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14287518-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: