Provider Demographics
NPI:1477109395
Name:T ROGER PEAY THERAPY
Entity Type:Organization
Organization Name:T ROGER PEAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-376-8775
Mailing Address - Street 1:273 W 100 N
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-6316
Mailing Address - Country:US
Mailing Address - Phone:801-376-8775
Mailing Address - Fax:
Practice Address - Street 1:150 N MAIN ST STE 204-2
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1671
Practice Address - Country:US
Practice Address - Phone:801-376-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health