MR. BRUCE WARELO SPERRY PT, PA-C - NPI 1760575518 - Physician Assistant in Holladay, UT

Q: What is the provider's specialty?

The provider's specialty is Physician Assistant with taxonomy code 363AS0400X and a focus in Surgical.

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About Mr. Bruce Warelo Sperry Pt, Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BRUCE WARELO SPERRY PT, PA-C (NPI 1760575518) is an individual surgical provider in Holladay, Utah, licensed in Utah (116471-1206) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Salt Lake City.

NPPES Registry Identity

NPI1760575518

Entity TypeIndividualMale

Primary Taxonomy363AS0400X

Provider Legal NameMR. BRUCE WARELO SPERRYCredential: PT, PA-C

Location Address4252 S HIGHLAND DR STE 200Holladay, UT 84124-2690

Mailing Address7181 S Campus View Dr Ste 200West Jordan, UT 84084-4312 · (801) 965-3600

Phone(801) 993-1800

Sole ProprietorNo

Enumeration DateOctober 2, 2006

Last NPPES UpdateFebruary 16, 2021

NPPES CertifiedFebruary 16, 2021

✔ NPI 1760575518 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in UT · 116471-1206

4252 S HIGHLAND DR STE 200, Holladay, UT 84124

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Secondary Practice Location 1

Location 1500 Foothill Blvd # 112Salt Lake City, UT 84148-0001 · Phone (801) 528-1565 ext. 5372 · Fax (801) 584-2587

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Bruce Warelo Sperry Pt, Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.