Healthcare Provider Details

I. General information

NPI: 1306864863
Provider Name (Legal Business Name): ROCKY MOUNTAIN THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S 4000 W STE 340
WEST VALLEY CITY UT
84120-3287
US

IV. Provider business mailing address

PO BOX 540640
NORTH SALT LAKE UT
84054-0640
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-5017
  • Fax: 801-417-5016
Mailing address:
  • Phone: 801-987-8700
  • Fax: 801-987-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number313389-2401
License Number StateUT

VIII. Authorized Official

Name: TY BERRETT
Title or Position: COO
Credential:
Phone: 801-243-2406