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NPI Code Detail

MEDICARE: ARIEL BRANDEN DPT

MEDICARE: ARIEL BRANDEN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist11343132-2401UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111343132-2401OTHERUTSTATE LICENSE

General Provider Information

NPI Number : 1134770209
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARIEL BRANDEN DPT
Provider Business Mailing Address
First Line : 1265 E FORT UNION BLVD STE 110
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1807
Country : US
Telephone Number : 801-849-0198
Fax Number : 801-849-0492
Provider Business Practice Location Address
First Line : 1265 E FORT UNION BLVD STE 110
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1807
Country : US
Telephone Number : 801-849-0198
Fax Number : 801-849-0492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2019
Last Update Date : 09/20/2019

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