Provider Demographics
NPI:1770876468
Name:TERRY, BRIAN JAMES (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:TERRY
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 1:6900 S 900 E
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5820
Mailing Address - Country:US
Mailing Address - Phone:801-755-9186
Mailing Address - Fax:
Practice Address - Street 1:50 E 9000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2201
Practice Address - Country:US
Practice Address - Phone:801-566-1613
Practice Address - Fax:801-352-0027
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7967542-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy