Individual
BRYAN HOLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21360 N 1460 E, MORONI, UT 84646-0461
(435) 445-5200
(435) 445-5201
Mailing address
PO BOX 461, MORONI, UT 84646-0461
(435) 445-5200
(435) 445-5201
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235458555
—
UT
Enumeration date
07/18/2014
Last updated
07/18/2014
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