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General NPI Number Information
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NPI Number | 1770405078
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Entity Type | Individual
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Provider Name | BRITTNEY WISE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 2472 S 300 E
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-2895
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Country | US
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Telephone | 801-466-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 356 S 900 E UNIT B3
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2796
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 14299508-4003
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License Number State | UT
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