OrganizationFunctionally Integrative Therapy LlcSocial WorkerBehavioral Health & Social Service ProvidersPractice Address5620 S Waterbury Way, Salt Lake City, UT 84121-1180(385) 208-6197PECOS EnrollmentBased on the most recent information from CMS, provider Functionally Integrative Therapy Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1184503492Provider TypeOrganizationFull NameFunctionally Integrative Therapy LlcSubpartNoEnumeration Date8/29/2025Last Updated8/29/2025Contact InformationPractice LocationPractice Address5620 S Waterbury Way, Salt Lake City, UT 84121-1180Phone(385) 208-6197FaxUnlisted FaxMailing LocationMailing AddressPO Box 18182, Kearns, UT 84118-0182Phone(385) 208-6197FaxUnlisted FaxAuthorized OfficialNameRoth, Steven (Owner/Therapist)Phone(385) 208-6197Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode261QM0850XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted Issuer