Provider Demographics
NPI:1932393261
Name:ALLRED, BREEANN VERNON (DPT)
Entity Type:Individual
Prefix:
First Name:BREEANN
Middle Name:VERNON
Last Name:ALLRED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N 400 E STE 106
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7595
Mailing Address - Country:US
Mailing Address - Phone:435-500-5862
Mailing Address - Fax:435-514-5447
Practice Address - Street 1:1400 N 500 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2455
Practice Address - Country:US
Practice Address - Phone:435-716-5010
Practice Address - Fax:435-716-5624
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6771549-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6771549-2401OtherLICENSURE NUMBER