Brodie James Pack, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT28869 Issued in CA

Practice address

11531 S District Dr Ste 1200
South Jordan, UT 84095-5782

Phone

(801) 260-3100

Fax

(801) 260-3101

NPI assigned

Dec 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pack Physical Therapy, Inc.Group PAC ID 2264681923, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pack Physical Therapy, Inc.

  • Physical Therapist
  • South Jordan, UT
  • NPI 1336413798
  Medicare reassignment Care Compare group Authorized official
• Pack Physical Therapy

  • Physical Therapy Clinic/Center
  • Dana Point, CA
  • NPI 1750537585
  NPD (past) Authorized official
• Grace Physical Therapy, Inc.

  • Specialist
  • Laguna Niguel, CA
  • NPI 1386668739
  NPD
• Rausch Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Laguna Niguel, CA
  • NPI 1538110861

  Physical Therapist

  NPD
• Deborah Weinstein Physical Therapy

  • Physical Therapist
  • Laguna Niguel, CA
  • NPI 1881961258
  NPD (past)
• Santa Margarita Medical Group

  • Specialist
  • Rancho Santa Margarita, CA
  • NPI 1619032208
  NPD (past)

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1871578203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11531 S DISTRICT DR STE 1200",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840955782",
            "telephone_number": "801-260-3100",
            "fax_number": "801-260-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11531 S DISTRICT DR STE 1200",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840955782",
            "telephone_number": "801-260-3100",
            "fax_number": "801-260-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "BRODIE",
        "middle_name": "JAMES",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "2774652-2401",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "UT",
            "license": "2774652-2401",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT28869",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "2774652-2401",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING",
            "identifier": "2774652-2401",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKinsey Owen, FNP-C
• Own My Health LLC
• P4 Pharmacy
• Heidi Pace
• Pack Physical Therapy, Inc.
• Cortney Breann Pack, LMT
• Cassandra Mara Padgett
• Keith Page, PHARMD
• Madison Page
• Diana Palandri, PHARMD

• Physical Therapist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.