Provider Demographics
NPI:1932827276
Name:ENGLESTEAD, BRADYK JONES (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:BRADYK
Middle Name:JONES
Last Name:ENGLESTEAD
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 1:166 W 1325 N STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7793
Mailing Address - Country:US
Mailing Address - Phone:435-586-0064
Mailing Address - Fax:
Practice Address - Street 1:1335 NORTHFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9490
Practice Address - Country:US
Practice Address - Phone:435-865-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12979200-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist