Provider Demographics
NPI:1720384647
Name:CONNER, JOCELYN BODKIN (DPT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:BODKIN
Last Name:CONNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:LEIGH
Other - Last Name:BODKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9641
Mailing Address - Country:US
Mailing Address - Phone:540-421-3900
Mailing Address - Fax:
Practice Address - Street 1:1480 N 400 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7525
Practice Address - Country:US
Practice Address - Phone:435-750-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225100000X
225100000X
UT77382942401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist