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NPI Code Detail

MEDICARE: BRIAN JAMES TERRY DPT

MEDICARE:   BRIAN JAMES TERRY  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
1261QP2000XPhysical Therapy Clinic/Center7967542-2401UT

General Provider Information

NPI Number : 1770876468
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN JAMES TERRY DPT
Provider Business Mailing Address
First Line : 6900 S 900 E
Second Line : STE 100
City : MIDVALE
State : UT
Zip : 84047-5820
Country : US
Telephone Number : 801-755-9186
Fax Number :
Provider Business Practice Location Address
First Line : 50 E 9000 S
Second Line :
City : SANDY
State : UT
Zip : 84070-2201
Country : US
Telephone Number : 801-566-1613
Fax Number : 801-352-0027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2011
Last Update Date : 10/25/2019

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