Provider Demographics
NPI:1851563084
Name:DESERET THERAPY, INC
Entity Type:Organization
Organization Name:DESERET THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:500 N. MARKET PLACE DR.
Mailing Address - Street 2:STE 203
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1709
Mailing Address - Country:US
Mailing Address - Phone:801-296-5105
Mailing Address - Fax:801-382-1098
Practice Address - Street 1:500 N MARKET PLACE DR
Practice Address - Street 2:STE 203
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1708
Practice Address - Country:US
Practice Address - Phone:801-296-5105
Practice Address - Fax:801-382-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation