Provider Demographics
NPI:1073872909
Name:PULSIPHER, BRAD ROBERT (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ROBERT
Last Name:PULSIPHER
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 1:13597 BLUEWING WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6316
Mailing Address - Country:US
Mailing Address - Phone:801-652-9363
Mailing Address - Fax:
Practice Address - Street 1:5734 W 13400 S
Practice Address - Street 2:SUITE 300
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6953
Practice Address - Country:US
Practice Address - Phone:801-302-7232
Practice Address - Fax:801-302-7237
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8211624-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist