Healthcare Provider Details

I. General information

NPI: 1467399915
Provider Name (Legal Business Name): BROOKE DIANNE HENDRICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 S 1300 E STE 200
SANDY UT
84094-4689
US

IV. Provider business mailing address

703 W 12260 S
DRAPER UT
84020-1658
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-0690
  • Fax:
Mailing address:
  • Phone: 949-290-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14237442-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: