MEDICARE: MS. JUDY LYNN ROBERTS CRT

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	2278S1500X	SNF/Subacute Care Certified Respiratory Therapist	4988384-5701	UT

General Provider Information

NPI Number	:	1912101858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY LYNN ROBERTS CRT

Provider Business Mailing Address
First Line	:	1079 E 6165 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1747
Country	:	US
Telephone Number	:	801-261-2390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4885 S 900 E
Second Line	:	SUITE 107
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5746
Country	:	US
Telephone Number	:	801-266-0399
Fax Number	:	801-266-0421

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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