Individual
BRODIE JAMES PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2774652-2401
UT
225100000X
Physical Therapist
Primary
PT28869
CA
2251S0007X
Sports Physical Therapist
2774652-2401
UT
2251X0800X
Orthopedic Physical Therapist
2774652-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2774652-2401
UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
UT
Enumeration date
12/08/2005
Last updated
02/07/2023
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