Brian H Pennock, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2852142401 Issued in UT

Practice address

5300 Adams Ave Pkwy
2B
Ogden, UT 84405-6902

Phone

(801) 475-0303

Fax

(801) 475-0101

NPI assigned

Sep 13, 2006

Last updated

Jul 21, 2008By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain Land Rehabilitation LLCGroup PAC ID 9234048745, 207 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain Land Rehabilitation LLC

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1265549372
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1982708418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 ADAMS AVE PKWY",
            "address_2": "2B",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056902",
            "telephone_number": "801-475-0303",
            "fax_number": "801-475-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 ADAMS AVE PKWY",
            "address_2": "2B",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056902",
            "telephone_number": "801-475-0303",
            "fax_number": "801-475-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNOCK",
        "first_name": "BRIAN",
        "middle_name": "H",
        "credential": "DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "2852142401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D3220",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Celeste Peeler, DPT
• Morgan Pellegrini, PA-C
• Braiden Pembelton
• Jakob Crane Pendleton, DO
• Talon Penman
• Peoplefirst Homecare & Hospice of Utah, LLC (Hearts for Home Health)
• Jason Pepper
• Michelle Pepper, MD
• Jonathan Percifield
• Jennifer A Perez, MOTR/L

• Physical Therapist in Ogden, UT
• Providers in Ogden, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; 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.