Provider Demographics
NPI:1770083859
Name:LANGTON, BRYAN JAMES (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JAMES
Last Name:LANGTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 S HIGHLAND CIR APT 14
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6073
Mailing Address - Country:US
Mailing Address - Phone:619-922-6544
Mailing Address - Fax:
Practice Address - Street 1:2390 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2027
Practice Address - Country:US
Practice Address - Phone:801-975-1600
Practice Address - Fax:801-975-1666
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10618586-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist