Healthcare Provider Details

I. General information

NPI: 1245154806
Provider Name (Legal Business Name): BRYNNE LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E 2700 S
SOUTH SALT LAKE UT
84115-3325
US

IV. Provider business mailing address

2268 W HARKER FARM LN
TAYLORSVILLE UT
84129-5412
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-2248
  • Fax:
Mailing address:
  • Phone: 479-389-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number88905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: