Provider Demographics
NPI:1407423478
Name:BOWDEN, BRANDI (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1031 N 475 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-3350
Mailing Address - Country:US
Mailing Address - Phone:385-201-6308
Mailing Address - Fax:
Practice Address - Street 1:1031 N 475 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-3350
Practice Address - Country:US
Practice Address - Phone:385-201-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6462702-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty