Healthcare Provider Details

I. General information

NPI: 1619068376
Provider Name (Legal Business Name): JEREMY FRANCIS BRANCH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WEST 400 NORTH
MOAB UT
84532
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171
US

V. Phone/Fax

Practice location:
  • Phone: 435-259-3600
  • Fax: 435-259-7718
Mailing address:
  • Phone: 801-942-3311
  • Fax: 801-942-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62218672401
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: