Provider Demographics
NPI:1003287178
Name:SKY ROOTS HEALING, PLLC
Entity type:Organization
Organization Name:SKY ROOTS HEALING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTMA
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:801-340-3040
Mailing Address - Street 1:2258 E FORT UNION BLVD STE B6
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4631
Mailing Address - Country:US
Mailing Address - Phone:801-340-3040
Mailing Address - Fax:888-398-9587
Practice Address - Street 1:2258 E FORT UNION BLVD STE B6
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-4631
Practice Address - Country:US
Practice Address - Phone:801-340-3040
Practice Address - Fax:888-398-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013328830Medicare UPIN