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General NPI Number Information
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NPI Number | 1568253334
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Entity Type | Organization
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Legal Business Name | REVISION TRAUMA THERAPY PLLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1429 S 550 E STE 230
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City | OREM
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State | UT
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Zip | 84097-7798
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Country | US
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Telephone | 385-275-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 7533 S CENTER VIEW CT # 4758
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City | WEST JORDAN
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State | UT
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Zip | 84084-5526
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Country | US
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Telephone | 385-275-2733
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MARTINA E BAILEY
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Credential | MSW ,LCSW
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Telephone | 385-275-2733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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