Provider Demographics
NPI:1992592836
Name:GOLDRUP, ALETHEA (TRT)
Entity type:Individual
Prefix:
First Name:ALETHEA
Middle Name:
Last Name:GOLDRUP
Suffix:
Gender:
Credentials:TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 W NEILL LN # NN101
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3291
Mailing Address - Country:US
Mailing Address - Phone:801-558-5134
Mailing Address - Fax:
Practice Address - Street 1:433 E 2700 S
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3325
Practice Address - Country:US
Practice Address - Phone:801-558-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8974687-4003226000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant