Individual provider Active NPI

Greg Brent Radcliffe, PTA

  • Physical Therapy Assistant
  • SLC, UT
National Provider Identifier
1245492388
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
2040 E Murray-Holladay Rd Suite 205
SLC, UT 84117
Phone
(801) 274-0299
NPI assigned
Jun 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X UT Primary

Addresses

Primary practice location

2040 E Murray-Holladay Rd Suite 205
SLC, UT 84117

Mailing address

2040 E Murray-Holladay Rd Suite 205
SLC, UT 84117
Phone (801) 274-0299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1245492388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 E MURRAY-HOLLADAY RD SUITE 205",
            "city": "SLC",
            "state": "UT",
            "postal_code": "84117",
            "telephone_number": "801-274-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 E MURRAY-HOLLADAY RD SUITE 205",
            "city": "SLC",
            "state": "UT",
            "postal_code": "84117",
            "telephone_number": "801-274-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADCLIFFE",
        "first_name": "GREG",
        "middle_name": "BRENT",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in SLC, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.