Provider Demographics
NPI:1215076682
Name:TAYLOR, BRENT F (DPT)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:F
Last Name:TAYLOR
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 1:3413 S 100 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6639
Mailing Address - Country:US
Mailing Address - Phone:801-292-3407
Mailing Address - Fax:
Practice Address - Street 1:3413 S 100 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6639
Practice Address - Country:US
Practice Address - Phone:801-292-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008334225100000X, 2251E1300X
UT66741782401225100000X
2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8407074Medicaid
WAG8854715Medicare PIN