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Contact Information

DEREK G RODEBACK, DO
1818 MUELLER PARK RD
BOUNTIFUL, UT84010-1105
 Phone: 453-414-9858
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

2081S0010X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for DEREK G RODEBACK · (Male)

NPI # 1053751032
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/05/2013
Last updated 05/22/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • CO License # DR.0061855
  • UT License # 12005709-1204
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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