Basic Information
| Provider Information | |||||||||
| NPI: | 1306864863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN THERAPY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 540640 | ||||||||
| Address2: | |||||||||
| City: | NORTH SALT LAKE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840540640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019878700 | ||||||||
| FaxNumber: | 8019878701 | ||||||||
| Practice Location | |||||||||
| Address1: | 3540 S 4000 W STE 340 | ||||||||
| Address2: | |||||||||
| City: | WEST VALLEY CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841203287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014175017 | ||||||||
| FaxNumber: | 8014175016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | BERRETT | ||||||||
| AuthorizedOfficialFirstName: | TY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8012432406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 313389-2401 | UT | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | UT | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1306864863 | 05 | UT | MEDICAID |