Provider Demographics
NPI:1912101858
Name:ROBERTS, JUDY LYNN (CRT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 E 6165 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1747
Mailing Address - Country:US
Mailing Address - Phone:801-261-2390
Mailing Address - Fax:
Practice Address - Street 1:4885 S 900 E
Practice Address - Street 2:SUITE 107
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5746
Practice Address - Country:US
Practice Address - Phone:801-266-0399
Practice Address - Fax:801-266-0421
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4988384-57012278S1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute Care