Healthcare Provider Details

I. General information

NPI: 1013023522
Provider Name (Legal Business Name): BRANDON DAVID GREENWOOD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N 500 E
LOGAN UT
84341-2455
US

IV. Provider business mailing address

1400 N 500 E
LOGAN UT
84341-2455
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-1000
  • Fax:
Mailing address:
  • Phone: 435-716-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5047921-2401
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: