Individual
JACOB BRANDENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5314 RIVER RUN DR, SUITE 140, PROVO, UT 84604-5691
(801) 471-2449
Mailing address
5314 RIVER RUN DR, SUITE 140, PROVO, UT 84604-5691
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11421
UT
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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