Provider Demographics
NPI:1881331536
Name:GUYMON, BRADLEY ALLAN (DPT, PT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ALLAN
Last Name:GUYMON
Suffix:
Gender:M
Credentials:DPT, 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 66
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-0066
Mailing Address - Country:US
Mailing Address - Phone:801-689-0200
Mailing Address - Fax:801-689-0201
Practice Address - Street 1:5957 FASHION POINT DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:801-827-0200
Practice Address - Fax:801-827-0201
Is Sole Proprietor?:No
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12447574-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist