Organization Active NPI

Worksite Wellness

  • Neurology Physical Therapist
  • Taylorsville, UT
National Provider Identifier
1013958479
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology Physical TherapistTaxonomy code 2251N0400X
License
4734414-2401 Issued in UT
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

Updated by the provider on Aug 22, 2020

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)CodeLicenseStatePrimary
Neurology Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
518960747001MedicaidUT

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.