MEDICARE: BRENT WEBB

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
1	225100000X	Physical Therapist	120650-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TPRA10491	OTHER	UT	MOLINA PROV # PROVO
2	577514	OTHER	UT	DMBA PROV # OGDEN
3	107001618103	OTHER	UT	IHC ADVOCATES # PROVO
4	5577514	OTHER	UT	DMBA PROV # PROVO
5	TPRA10491	OTHER	UT	MOLINA PROV # OGDEN

General Provider Information

NPI Number	:	1154376838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT WEBB

Provider Business Mailing Address
First Line	:	1466 FLINT CT
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-9534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 E RIDGELINE DR
Second Line	:	#51
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-4946
Country	:	US
Telephone Number	:	801-479-5777
Fax Number	:	801-479-7005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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Directions to “ BRENT WEBB ” Practice Location

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