Healthcare Provider Details

I. General information

NPI: 1831465244
Provider Name (Legal Business Name): MICHAEL JAMES BRAGINTON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

1443 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-0990
  • Fax: 801-225-4067
Mailing address:
  • Phone: 801-225-0990
  • Fax: 801-225-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number122253-2401
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: