Individual
BRANDI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2572 E SOUTH WEBER DR STE 5, SOUTH WEBER, UT 84405-9550
(801) 479-7045
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11189504-2401
PT LICENSE
UT
Enumeration date
03/15/2019
Last updated
03/15/2019
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