Bruce Warelo Sperry, PT, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

116471-1206 Issued in UT

Practice address

4252 S Highland Dr Ste 200
Holladay, UT 84124-2690

Phone

(801) 993-1800

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Granger Medical Clinic PC

  • Multi-Specialty Clinic/Center
  • West Valley City, UT
  • NPI 1184657041
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1760575518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7181 S CAMPUS VIEW DR STE 200",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840844312",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4252 S HIGHLAND DR STE 200",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841242690",
            "telephone_number": "801-993-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Foothill Blvd # 112",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841480001",
            "country_code": "US",
            "telephone_number": "801-528-1565 x5372",
            "fax_number": "801-584-2587",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPERRY",
        "first_name": "BRUCE",
        "middle_name": "WARELO",
        "name_prefix": "Mr.",
        "credential": "PT, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "116471-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen B Smith, MD
• Carly Brooke Snow, MA, AMFT, 1000-ERYT
• Madison McGregor Snow
• Steven B Soelbert, DMD
• Speech Superstars
• Standard Optical Co
• Steady and Well LLC
• Brett Allen Stephens, DMD
• Daniel Stephens, DMD
• Heather J Stevens, LMT

• Surgical Physician Assistant in Holladay, UT
• Providers in Holladay, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.