Healthcare Provider Details

I. General information

NPI: 1417864869
Provider Name (Legal Business Name): EVELYN BRANT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S STATE ST STE C110
OREM UT
84058-5729
US

IV. Provider business mailing address

502 W 2100 N
LEHI UT
84043-9726
US

V. Phone/Fax

Practice location:
  • Phone: 801-850-9146
  • Fax: 801-373-7486
Mailing address:
  • Phone: 707-972-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: