Provider Demographics
NPI:1609006741
Name:STILSON, BRAD (DPT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:STILSON
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 1:425 S VERNAL AVE
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-3237
Mailing Address - Country:US
Mailing Address - Phone:435-781-1502
Mailing Address - Fax:435-781-1505
Practice Address - Street 1:425 S VERNAL AVE
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-3237
Practice Address - Country:US
Practice Address - Phone:435-781-1502
Practice Address - Fax:435-781-1505
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7298027-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist