MEDICARE: PRESTON BRENT HALL PT

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	48009852401	UT

General Provider Information

NPI Number	:	1386747707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESTON BRENT HALL PT

Provider Business Mailing Address
First Line	:	1794 OLYMPIC PKWY
Second Line	:	STE 140
City	:	PARK CITY
State	:	UT
Zip	:	84098-6389
Country	:	US
Telephone Number	:	435-575-0345
Fax Number	:	435-575-0346

Provider Business Practice Location Address
First Line	:	1526 UTE BLVD STE 102
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7537
Country	:	US
Telephone Number	:	435-575-0345
Fax Number	:	435-575-0346

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	10/11/2017

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Directions to “ PRESTON BRENT HALL PT” Practice Location

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