Provider Demographics
NPI:1811296155
Name:PRECISION EMG PLLC
Entity type:Organization
Organization Name:PRECISION EMG PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT-ECS
Authorized Official - Phone:801-725-2380
Mailing Address - Street 1:PO BOX 12723
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412-2723
Mailing Address - Country:US
Mailing Address - Phone:801-725-2380
Mailing Address - Fax:801-675-5103
Practice Address - Street 1:3225 W GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6508
Practice Address - Country:US
Practice Address - Phone:801-725-2380
Practice Address - Fax:801-675-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2852412401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty