Provider Demographics
NPI:1750072153
Name:BONNEVILLE PELVIC HEALTH
Entity type:Organization
Organization Name:BONNEVILLE PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BAILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-510-1319
Mailing Address - Street 1:1220 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0319
Mailing Address - Country:US
Mailing Address - Phone:801-510-1319
Mailing Address - Fax:
Practice Address - Street 1:1220 28TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0319
Practice Address - Country:US
Practice Address - Phone:801-510-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy