Individual
BRIAN H PENNOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, ATC
Contact information
Practice address
5300 ADAMS AVE PKWY, 2B, OGDEN, UT 84405-6902
(801) 475-0303
(801) 475-0101
Mailing address
5300 ADAMS AVE PKWY, 2B, OGDEN, UT 84405-6902
(801) 475-0303
(801) 475-0101
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2852142401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D3220
—
UT
Enumeration date
09/13/2006
Last updated
07/21/2008
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