Provider Demographics
NPI:1275942062
Name:BOND, NICOLE SOBOTKA (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SOBOTKA
Last Name:BOND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 N EAST CAPITOL BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2139
Mailing Address - Country:US
Mailing Address - Phone:402-276-3958
Mailing Address - Fax:
Practice Address - Street 1:1160 E 3900 S STE 4000
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1264
Practice Address - Country:US
Practice Address - Phone:385-295-5087
Practice Address - Fax:385-295-4088
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012836225100000X
UT12373136-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist