Provider Demographics
NPI:1942669833
Name:BRINKERHOFF, JACE
Entity Type:Individual
Prefix:
First Name:JACE
Middle Name:
Last Name:BRINKERHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1958
Mailing Address - Country:US
Mailing Address - Phone:801-489-5669
Mailing Address - Fax:801-489-5783
Practice Address - Street 1:15 S 1000 E STE 25
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5595
Practice Address - Country:US
Practice Address - Phone:801-465-5610
Practice Address - Fax:801-465-5615
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9634510-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT171959388OtherUTAH DRIVER LICENSE