Provider Demographics
NPI:1174733281
Name:BROWN, BRYAN QUINN (LMT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:QUINN
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E 1000 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1850
Mailing Address - Country:US
Mailing Address - Phone:435-979-8170
Mailing Address - Fax:
Practice Address - Street 1:80 E 1000 N
Practice Address - Street 2:SUITE B
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1850
Practice Address - Country:US
Practice Address - Phone:435-979-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5968755-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist