Healthcare Provider Details

I. General information

NPI: 1346784410
Provider Name (Legal Business Name): WESLEY HYDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 N 400 E STE B
NORTH LOGAN UT
84341-1799
US

IV. Provider business mailing address

560 W 465 N STE 604
PROVIDENCE UT
84332-8006
US

V. Phone/Fax

Practice location:
  • Phone: 435-774-8557
  • Fax: 435-774-8587
Mailing address:
  • Phone: 435-753-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: