Healthcare Provider Details

I. General information

NPI: 1952637167
Provider Name (Legal Business Name): ROCKY MOUNTAIN THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 WEST 3500 SOUTH, FL 1
WEST VALLEY CITY UT
84119-3602
US

IV. Provider business mailing address

PO BOX 702128
SALT LAKE CITY UT
84170-2128
US

V. Phone/Fax

Practice location:
  • Phone: 801-679-0123
  • Fax: 801-996-8743
Mailing address:
  • Phone: 801-797-9585
  • Fax: 801-677-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL G WORTLEY
Title or Position: PRESIDENT
Credential: PT
Phone: 801-294-6907