Active NPI
Worksite Wellness
- Neurology Physical Therapist
- Taylorsville, UT
National Provider Identifier
1013958479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physical Therapist
- License
- 4734414-2401
- Legal business name
- WORKSITE WELLNESS
- Practice address
- 2520 W 4700 S
Taylorsville, UT 84118-1847 - Phone
- (801) 599-6412
- Fax
- (801) 964-2435
- NPI assigned
- Jun 9, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Eric Deloyq Roberts, MSPT
- Title
- Ceo
- Phone
- (801) 599-6412
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physical Therapist | 2251N0400X | 4734414-2401 | UT | Primary |
Addresses
Primary practice location
2520 W 4700 S
Taylorsville, UT 84118-1847
Mailing address
249 N Main St
North Salt Lake, UT 84054-2438
Phone (801) 599-6412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 518960747001 | Medicaid | UT |
National Provider Directory
National Provider DirectoryLocations
2520 W 4700 S
Taylorsville, UT 84129
Phone (801) 599-6412
2520 W 4700 S
Ste A2
Taylorsville, UT 84129
Phone (801) 599-6412
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatrics Physician
- Taylorsville, UT
- NPI 1376510800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1013958479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "249 N MAIN ST",
"city": "NORTH SALT LAKE",
"state": "UT",
"postal_code": "840542438",
"telephone_number": "801-599-6412",
"fax_number": "801-964-2435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 W 4700 S",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841181847",
"telephone_number": "801-599-6412",
"fax_number": "801-964-2435"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WORKSITE WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-09",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "ROBERTS",
"authorized_official_first_name": "ERIC",
"authorized_official_middle_name": "DELOYQ",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "801-599-6412",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MSPT"
},
"taxonomies": [
{
"code": "2251N0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist, Neurology",
"state": "UT",
"license": "4734414-2401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "518960747001",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Taylorsville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.