Provider Demographics
NPI:1558246769
Name:ROOF, TYLER (RD, CSSD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ROOF
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 S PINE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017-9362
Mailing Address - Country:US
Mailing Address - Phone:678-863-1938
Mailing Address - Fax:
Practice Address - Street 1:2094 S PINE MEADOW DR
Practice Address - Street 2:
Practice Address - City:COALVILLE
Practice Address - State:UT
Practice Address - Zip Code:84017-9362
Practice Address - Country:US
Practice Address - Phone:678-863-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13073914-4901133VN1501X
UT86169963133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics