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General NPI Number Information
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NPI Number | 1154376838
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Entity Type | Individual
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Provider Name | BRENT WEBB
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1452 E RIDGELINE DR #51
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4946
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Country | US
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Telephone | 801-479-5777
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Fax | 801-479-7005
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Provider Business Mailing Address
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Address Line | 1466 FLINT CT
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City | KAYSVILLE
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State | UT
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Zip | 84037-9534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 120650-2401
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License Number State | UT
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