Provider Demographics
NPI:1700296563
Name:BREMNER, CODY (PHD, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BREMNER
Suffix:
Gender:M
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W UNIVERSITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-0001
Mailing Address - Country:US
Mailing Address - Phone:435-531-3606
Mailing Address - Fax:358-658-5074
Practice Address - Street 1:351 W UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-0001
Practice Address - Country:US
Practice Address - Phone:435-531-3606
Practice Address - Fax:435-865-8507
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10384140-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer