Provider Demographics
NPI:1932182243
Name:BODEN, ERINLEE (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:ERINLEE
Middle Name:
Last Name:BODEN
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S 3200 W STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9623
Mailing Address - Country:US
Mailing Address - Phone:801-561-1061
Mailing Address - Fax:801-561-1570
Practice Address - Street 1:9001 S 3200 W STE 1
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9623
Practice Address - Country:US
Practice Address - Phone:801-561-1061
Practice Address - Fax:801-561-1570
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24599225100000X
UT3285392401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT245990Medicare PIN