Healthcare Provider Details

I. General information

NPI: 1932790524
Provider Name (Legal Business Name): SCOTT RUSSELL JEPPSON PT,DPT,CERT.VRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 S MAIN ST
BLANDING UT
84511-3924
US

IV. Provider business mailing address

338 W 100 N
BLANDING UT
84511-4108
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016867
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: