Provider Demographics
NPI:1801491576
Name:REDFORD, BREANNE LOUISE (DPT)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:LOUISE
Last Name:REDFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13358 S 5600 W
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6789
Mailing Address - Country:US
Mailing Address - Phone:801-302-7230
Mailing Address - Fax:801-302-7237
Practice Address - Street 1:3943 E PONY EXPRESS PKWY STE 220
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5545
Practice Address - Country:US
Practice Address - Phone:801-302-7230
Practice Address - Fax:801-789-7444
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8242367-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist