Healthcare Provider Details

I. General information

NPI: 1659264828
Provider Name (Legal Business Name): BRYON ISRAELSEN GEDDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 W 2700 N STE 102
PLEASANT VIEW UT
84404-1251
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-5133
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14222237-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: