Provider Demographics
NPI:1083446207
Name:REED, BRANDON (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4871 HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7966
Mailing Address - Country:US
Mailing Address - Phone:435-757-5383
Mailing Address - Fax:
Practice Address - Street 1:550 W 465 N
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8014
Practice Address - Country:US
Practice Address - Phone:435-535-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139892082401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist