MEDICARE: GARRETT ROUNTREE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053141465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT ROUNTREE PT

Provider Business Mailing Address
First Line	:	5959 MAPLE AVE APT 1242
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6696
Country	:	US
Telephone Number	:	409-679-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1787 E FORT UNION BLVD STE 101
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2868
Country	:	US
Telephone Number	:	385-526-3945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/13/2024

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