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NPI Code Detail

MEDICARE: JONATHAN LAVAN BUNDY PT, DPT

MEDICARE: JONATHAN LAVAN BUNDY PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1255738118
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN LAVAN BUNDY PT, DPT
Provider Business Mailing Address
First Line : 4949 S 3535 W
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84129-2947
Country : US
Telephone Number : 435-757-7546
Fax Number :
Provider Business Practice Location Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-792-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2014
Last Update Date : 06/05/2022

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