=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427919042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BODYIQ TELEHEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2025
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1538 ROSANNA LN
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84004-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-361-4381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1538 ROSANNA LN
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84004-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-361-4381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | BRANDON TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-361-4381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------