Provider Demographics
NPI:1053141465
Name:ROUNTREE, GARRETT (PT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 MAPLE AVE APT 1242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6696
Mailing Address - Country:US
Mailing Address - Phone:409-679-5345
Mailing Address - Fax:
Practice Address - Street 1:1787 E FORT UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2868
Practice Address - Country:US
Practice Address - Phone:385-526-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist