Individual
MR. BRAD A MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
555 WEST SR 164, SALEM, UT 84653
(385) 203-1313
(801) 429-0629
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5003636-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50036362401001
BCBS PPO
UT
Enumeration date
05/24/2006
Last updated
05/04/2026
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