Provider Demographics
NPI:1043650047
Name:BROUGHTON, ALEX (DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004
Mailing Address - Country:US
Mailing Address - Phone:801-499-6560
Mailing Address - Fax:
Practice Address - Street 1:655 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2027
Practice Address - Country:US
Practice Address - Phone:801-704-9405
Practice Address - Fax:801-704-9407
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7650433-2401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7650433-2401OtherPHYSICAL THERAPIST