Provider Demographics
NPI:1225219991
Name:BRIAN J. RODRIGUEZ, PT, PC
Entity Type:Organization
Organization Name:BRIAN J. RODRIGUEZ, PT, PC
Other - Org Name:UTAH PHYSICAL THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OSC
Authorized Official - Phone:801-561-1061
Mailing Address - Street 1:450 ADALEY AVE
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6562
Mailing Address - Country:US
Mailing Address - Phone:801-269-9322
Mailing Address - Fax:
Practice Address - Street 1:9001 S 3200 W STE 1
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9623
Practice Address - Country:US
Practice Address - Phone:801-561-1061
Practice Address - Fax:801-561-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1195562401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty