Mr Brad A Mangum, PT | |
555 West Sr 164, Salem, UT 84653 | |
(385) 203-1313 | |
(801) 429-0629 |
Full Name | Mr Brad A Mangum |
---|---|
Gender | Male |
Speciality | Physical Therapy |
Experience | 23 Years |
Location | 555 West Sr 164, Salem, Utah |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316992548 | NPI | - | NPPES |
50036362401001 | Other | UT | BCBS PPO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 5003636-2401 (Utah) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Central Utah Clinic Pc | 7517868508 | 386 |
Provider Name | Central Utah Clinic Pc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1093764805 PECOS PAC ID: 7517868508 Enrollment ID: O20040113000805 |
Provider Name | Physical & Sports Therapy Services, Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1326149865 PECOS PAC ID: 3678565959 Enrollment ID: O20040330001082 |
Mailing Address | Practice Location Address |
---|---|
Mr Brad A Mangum, PT 1055 N 500 W Attn: Credentialing, Provo, UT 84604 Ph: (801) 354-8225 | Mr Brad A Mangum, PT 555 West Sr 164, Salem, UT 84653 Ph: (385) 203-1313 |
Kashley Carter, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 416 N State Road 198, Salem, UT 84653 Phone: 801-423-8600 | |
Alex S Moore, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 385-203-1313 | |
Darren H Averett, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 555 West Sr 164, Salem, UT 84653 Phone: 385-203-1313 Fax: 801-429-0629 | |
Samuel Metz, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 416 N State Road 198, Salem, UT 84653 Phone: 801-423-8600 | |
Mr. Paul Durant Stoneman, PT, PHD Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 555 West Sr 164, Salem, UT 84653 Phone: 385-203-1313 Fax: 801-429-0629 |