Organization
ROOTS PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN THOMPSON PHD, OTR/L (OWNER)
(907) 744-3978
Entity
Organization
Contact information
Practice address
5976 KINGSFORD AVE, PARK CITY, UT 84098-6315
(907) 744-3978
Mailing address
5976 KINGSFORD AVE, PARK CITY, UT 84098-6315
(907) 744-3978
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972843712
—
UT
Enumeration date
05/12/2020
Last updated
05/12/2020
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