Provider Demographics
NPI:1457929267
Name:PERCIVAL, BRANDI (PT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70689
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84170-0689
Mailing Address - Country:US
Mailing Address - Phone:801-987-8600
Mailing Address - Fax:
Practice Address - Street 1:8822 S REDWOOD RD STE E122
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9273
Practice Address - Country:US
Practice Address - Phone:801-566-7080
Practice Address - Fax:801-748-1750
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10738971-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist