1164455887 NPI number — MR. BRADY K ENGLESTEAD M.P.T.

Table of content: MR. BRADY K ENGLESTEAD M.P.T. (NPI 1164455887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164455887 NPI number — MR. BRADY K ENGLESTEAD M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGLESTEAD
Provider First Name:
BRADY
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164455887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 W 1325 N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84720-7792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-586-0064
Provider Business Mailing Address Fax Number:
435-867-1243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 W 1325 N
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-7792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-586-0064
Provider Business Practice Location Address Fax Number:
435-867-1243
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  277598-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107009571103 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 650019319 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 190649300 . This is a "OWCP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 638841 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 94277598204001 . This is a "BCBS TRADITONAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: PRA03531 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 080086 . This is a "IHC SELECT MED" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870656237BE1 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 59795 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 94277598202001 . This is a "BCBS PPO" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2012098 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5650341 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 64-00636 . This is a "UNITED HEALT CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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