Provider Demographics
NPI:1164455887
Name:ENGLESTEAD, BRADY K (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRADY
Middle Name:K
Last Name:ENGLESTEAD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7792
Mailing Address - Country:US
Mailing Address - Phone:435-586-0064
Mailing Address - Fax:435-867-1243
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7792
Practice Address - Country:US
Practice Address - Phone:435-586-0064
Practice Address - Fax:435-867-1243
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277598-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107009571103OtherSELECT HEALTH
UT650019319OtherRAILROAD MEDICARE
UT190649300OtherOWCP
UT638841OtherDMBA
UT94277598204001OtherBCBS TRADITONAL
UTPRA03531OtherMOLINA
UT080086OtherIHC SELECT MED
UT870656237BE1OtherEDUCATORS MUTUAL
UT59795OtherPEHP
UT94277598202001OtherBCBS PPO
UT2012098OtherFIRST HEALTH
UT5650341OtherAETNA
UT64-00636OtherUNITED HEALT CARE
UT638841OtherDMBA
UT650019319OtherRAILROAD MEDICARE