Road Back LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

ROAD BACK LLC

Doing business as

The Road Back to Wellness

Practice address

1818 Mueller Park Rd
Bountiful, UT 84010-1105

Phone

(435) 414-9858

NPI assigned

May 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derek Garn Rodeback, DO

Title

Sole MBR

Phone

(435) 414-9858

Specialties & licenses 1

Addresses

Other names 1

• The Road Back to Wellness Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Edmand Rodeback, PHD

  • Clinical Social Worker
  • Salt Lake City, UT
  • NPI 1679746846
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1598339905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 MUELLER PARK RD",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840101105",
            "telephone_number": "435-414-9858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 MUELLER PARK RD",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840101105",
            "telephone_number": "435-414-9858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROAD BACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "RODEBACK",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "GARN",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "435-414-9858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Road Back to Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Paul Rigby
• Zach Riordan
• Brenda M Ritson, MD
• Kiara Rivera
• Marissa Sophia Rivera
• Robert D. Hazen D.D.S., PC
• Robert W. Jordan MD PC
• Brooklyn Roberts
• Kyra Roberts
• Cara Michelle Robinson, CMHC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.