Healthcare Provider Details
I. General information
NPI: 1164455887
Provider Name (Legal Business Name): BRADY K ENGLESTEAD M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
166 W 1325 N SUITE 100
CEDAR CITY UT
84720-7792
US
IV. Provider business mailing address
166 W 1325 N SUITE 100
CEDAR CITY UT
84720-7792
US
V. Phone/Fax
- Phone: 435-586-0064
- Fax: 435-867-1243
- Phone: 435-586-0064
- Fax: 435-867-1243
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 277598-2401 |
| License Number State | UT |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 107009571103 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | SELECT HEALTH |
| # 2 | |
| Identifier | 650019319 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | RAILROAD MEDICARE |
| # 3 | |
| Identifier | 190649300 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | OWCP |
| # 4 | |
| Identifier | 638841 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | DMBA |
| # 5 | |
| Identifier | 94277598204001 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | BCBS TRADITONAL |
| # 6 | |
| Identifier | PRA03531 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | MOLINA |
| # 7 | |
| Identifier | 080086 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | IHC SELECT MED |
| # 8 | |
| Identifier | 870656237BE1 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | EDUCATORS MUTUAL |
| # 9 | |
| Identifier | 59795 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | PEHP |
| # 10 | |
| Identifier | 94277598202001 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | BCBS PPO |
| # 11 | |
| Identifier | 2012098 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | FIRST HEALTH |
| # 12 | |
| Identifier | 5650341 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | AETNA |
| # 13 | |
| Identifier | 64-00636 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | UNITED HEALT CARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
