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1720167752
BRANDON KENNETH BLISS
PROVO, UT
NPI
1720167752
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: UT 3085245-2401)
Enumeration Date
2006-11-02
Last Update Date
2007-11-13
Business Address
-- BRANDON KENNETH BLISS DPT
3303 N UNIVERSITY AVE
PROVO, UT 84604-4438
Phone number: 801-373-7438
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Mailing Address
-- BRANDON KENNETH BLISS DPT
PO BOX 307
BOUNTIFUL, UT 84011-0307
Phone number: 888-700-6907
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