MEDICARE: BRADLEY JAMES POWELL 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
1	225100000X	Physical Therapist	11293819-2401	UT

General Provider Information

NPI Number	:	1568055366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JAMES POWELL DPT

Provider Business Mailing Address
First Line	:	1628 W 11010 S STE 101
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-1278
Country	:	US
Telephone Number	:	208-287-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 E FORT UNION BLVD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1889
Country	:	US
Telephone Number	:	801-405-9272
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	05/13/2026

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