MEDICARE: JONATHAN DAVID BROWER

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
1	225200000X	Physical Therapy Assistant	12157995-2402	UT

General Provider Information

NPI Number	:	1841927134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DAVID BROWER

Provider Business Mailing Address
First Line	:	5907 W FOX RIVER LN
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84118-9337
Country	:	US
Telephone Number	:	801-502-0837
Fax Number	:

Provider Business Practice Location Address
First Line	:	5907 W FOX RIVER LN
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84118-9337
Country	:	US
Telephone Number	:	801-502-0837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “ JONATHAN DAVID BROWER ” Practice Location

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