Individual provider Active NPI

Brent L. Miller, P.T.

  • Physical Therapist
  • Sandy, UT
National Provider Identifier
1720065840
Registry record updated Jun 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
373121-2401 Issued in UT
Practice address
9720 S 1300 E
#W200
Sandy, UT 84094
Phone
(801) 572-0690
Fax
(801) 572-0690
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 373121-2401 UT Primary

Addresses

Primary practice location

9720 S 1300 E
#W200
Sandy, UT 84094

Mailing address

9720 S 1300 E
#W200
Sandy, UT 84094
Phone (801) 572-0690

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040217000550 UT Practitioner - Physical Therapist in Private Practice 3577458744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Registered Physical Therapists IncGroup PAC ID 9537151733, 64 clinicians

Practice addresses (Care Compare)

12391 S 4000
Suite 210
Riverton, UT 84096-7035
Phone (801) 446-0990

1577 W 7000
Suite 100
West Jordan, UT 84084-7493
Phone (801) 566-6301

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
373121-2401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Registered Physical Therapists LLC CurrentSince Mar 1, 2005 Accepting new patients

Locations

12391 S 4000 W
Ste 210
Riverton, UT 84096
Phone (801) 446-0990

9844 S 1300 E
Ste 300
Sandy, UT 84094
Phone (801) 572-0690

1577 W 7000 S
Ste 100
West Jordan, UT 84084
Phone (801) 566-6301

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276214400000",
    "number": "1720065840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9720 S 1300 E",
            "address_2": "#W200",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84094",
            "telephone_number": "801-572-0690",
            "fax_number": "801-572-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9720 S 1300 E",
            "address_2": "#W200",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84094",
            "telephone_number": "801-572-0690",
            "fax_number": "801-572-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRENT",
        "middle_name": "L.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2010-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "373121-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.