Healthcare Provider Details

I. General information

NPI: 1003658618
Provider Name (Legal Business Name): PARKER JOENS PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 STADIUM WAY DEPT 2701
OGDEN UT
84408-2701
US

IV. Provider business mailing address

3870 STADIUM WAY DEPT 2701
OGDEN UT
84408-2701
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-7712
  • Fax: 801-626-7264
Mailing address:
  • Phone: 801-626-7712
  • Fax: 801-626-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6069
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: