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General NPI Number Information
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NPI Number | 1992592836
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Entity Type | Individual
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Provider Name | ALETHEA GOLDRUP TRT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 433 E 2700 S
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-3325
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Country | US
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Telephone | 801-558-5134
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 W NEILL LN # NN101
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City | RIVERTON
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State | UT
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Zip | 84096-3291
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Country | US
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Telephone | 801-558-5134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 226000000X
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Taxonomy Name | Recreational Therapist Assistant
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License Number | 8974687-4003
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License Number State | UT
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