MEDICARE: DOUGLAS K BAGLEY 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	2251H1200X	Hand Physical Therapist	121795-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77717	OTHER	UT	PEHP
2	6400377	OTHER	UT	UNITED HEALTHCARE
3	0224632005	OTHER	UT	CIGNA

General Provider Information

NPI Number	:	1538155411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS K BAGLEY PT

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:	CREDENTIALING DEPARTMENT
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	1055 N 500 W
Second Line	:	SUITE 207
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-375-4263
Fax Number	:	801-429-8085

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	11/27/2023

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Directions to “ DOUGLAS K BAGLEY PT” Practice Location

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