Provider Demographics
NPI:1699197749
Name:BRIGHTON REHABILITATION
Entity Type:Organization
Organization Name:BRIGHTON REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL RECRUITER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-495-5279
Mailing Address - Street 1:500 ELLIOTT AVE W
Mailing Address - Street 2:APT 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3969
Mailing Address - Country:US
Mailing Address - Phone:814-331-2326
Mailing Address - Fax:
Practice Address - Street 1:1952 E 7000 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6877
Practice Address - Country:US
Practice Address - Phone:801-495-5279
Practice Address - Fax:801-495-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60424838261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service