Provider Demographics
NPI:1336223007
Name:RODRIGUEZ, BRIAN J (PT DPT OCS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT DPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E ADALEY AVE
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6562
Mailing Address - Country:US
Mailing Address - Phone:801-808-9384
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S STE 208
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8146
Practice Address - Country:US
Practice Address - Phone:801-808-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119556-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist