Healthcare Provider Details

I. General information

NPI: 1700725496
Provider Name (Legal Business Name): REX WYNN BRYCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 W 800 S APT A612
OREM UT
84058-6359
US

IV. Provider business mailing address

1435 W 800 S APT A612
OREM UT
84058-6359
US

V. Phone/Fax

Practice location:
  • Phone: 801-473-5821
  • Fax: 801-473-5821
Mailing address:
  • Phone: 801-473-5821
  • Fax: 801-473-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9386726-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: