MEDICARE: JONATHAN BAWDEN 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
1	225100000X	Physical Therapist	11285965-2401	UT
2	225100000X	Physical Therapist	PT-2023-2324	NM

General Provider Information

NPI Number	:	1437716768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN BAWDEN DPT

Provider Business Mailing Address
First Line	:	2532 E 3300 S APT 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1091 W S JORDAN PKWY STE 500
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8841
Country	:	US
Telephone Number	:	385-887-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	10/20/2023

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