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General NPI Number Information
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NPI Number | 1730581570
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Entity Type | Individual
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Provider Name | BRANDEN JORGENSEN DPT
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Gender | Male
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 1868 W 9800 S 200
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4713
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Country | US
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Telephone | 801-676-2210
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Fax | 801-676-2212
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Provider Business Mailing Address
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Address Line | 9720 S 1300 E #W200
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City | SANDY
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State | UT
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Zip | 84094-3712
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Country | US
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Telephone | 801-572-0690
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Fax | 801-572-0696
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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 | 91336962401
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License Number State | UT
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