Healthcare Provider Details

I. General information

NPI: 1841851516
Provider Name (Legal Business Name): LINDSAY T BOGNAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 833-577-3422
  • Fax: 801-662-4930
Mailing address:
  • Phone: 833-577-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9535438-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: