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NPI Code Detail

MEDICARE: BRENT NELSON LOSEE DPT

MEDICARE: BRENT NELSON LOSEE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10636331-8016UT

General Provider Information

NPI Number : 1841790037
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT NELSON LOSEE DPT
Provider Business Mailing Address
First Line : 1628 W 11010 S STE 101
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-1278
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1628 W 11010 S STE 101
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-1278
Country : US
Telephone Number : 801-613-1890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 03/31/2026

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