Active NPI
Cynthia Clubb, TRT
- Recreation Therapist
- Taylorsville, UT
National Provider Identifier
1033976287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 321593-4003
- Practice address
- 6246 S Redwood Rd
Taylorsville, UT 84123-6600 - Phone
- (801) 969-1420
- NPI assigned
- Mar 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 321593-4003 | UT | Primary |
Addresses
Primary practice location
6246 S Redwood Rd
Taylorsville, UT 84123-6600
Mailing address
6246 S Redwood Rd
Taylorsville, UT 84123-6600
Phone (801) 969-1420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 321593-4003 | UT | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709510400000",
"number": "1033976287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6246 S REDWOOD RD",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841236600",
"telephone_number": "801-969-1420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6246 S REDWOOD RD",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841236600",
"telephone_number": "801-969-1420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUBB",
"first_name": "CYNTHIA",
"credential": "TRT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-04",
"last_updated": "2024-03-04",
"certification_date": "2024-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "UT",
"license": "321593-4003",
"primary": true
}
],
"identifiers": [],
"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 Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.