# LEGENDARY PEDIATRIC THERAPY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Functionabilities, Functionabilities
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568869899
- **Authorized official:** BREEANN MILLETTE (BILLING MANAGER)
- **Authorized official phone:** (801) 443-7775

## Contact information

- **Practice address:** 12453 S 265 W STE B, DRAPER, UT 84020-5420
- **Practice address phone:** (801) 443-7775
- **Practice address fax:** (801) 447-0107
- **Mailing address:** 12453 S 265 W STE B, DRAPER, UT 84020-5420
- **Mailing address phone:** (801) 443-7775
- **Mailing address fax:** (801) 447-0107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | — | NULL | — |
| 225700000X | Massage Therapist | 5044485-4701 | UT | — |
| 225X00000X | Occupational Therapist | 5044485-4201 | UT | — |
| 225X00000X | Occupational Therapist | 6717450-4201 | UT | Yes |
| 235Z00000X | Speech-Language Pathologist | 9554558-4102 | UT | — |

## Other

- **Enumeration date:** 12/02/2014
- **Last updated:** 10/12/2026