BROCK BODILY (NPI# 1366004517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366004517 |
| Entity Type | Individual |
| Full Name | BROCK BODILY |
| Practice Address |
10623 S Redwood Rd # 101 South Jordan UT 84095-2481 |
| Mailing Address |
1265 N 850 E Pleasant Grove UT 84062-1998 |
| Practice Telephone | 8015664242 |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2019-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
11353289-8002 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
10623 S REDWOOD RD # 101 |
| City | SOUTH JORDAN |
| State | UT |
| Zip Code | 84095-2481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033745393 | Beverly Laraine Williams | Social Worker | 11260 S River Heights Drive, South Jordan, UT 84095 | 2020-03-19 |
| 1265902902 | Sarah Richele Kelley | Specialist/Technologist | 10236 Alder Grovey Way, South Jordan, UT 84095 | 2018-11-26 |
| 1326528837 | Kristi Couse | Massage Therapist | 10679 S 2200 W Apt 2, South Jordan, UT 84095 | 2018-08-15 |
| 1821516063 | River Crossing Dental Professional Corporation | Clinic/Center | 12427 South 4000 West, Suite #200, Riverton, UT 84095 | 2017-09-08 |
| 1245755719 | Staci Stout | Dental Hygienist | 3113 W Swiss Pass Cir, South Jordan, UT 84095 | 2017-08-07 |
| 1437698750 | Ryan Sears | Dentist | 10894 So. River Front Parkway, South Jordan, UT 84095 | 2017-02-20 |
| 1366989931 | Ultimate Sports Regenerative Medicine | Chiropractor | 1098 W. South Jordan Pkwy, Suite 101, South Jordan, UT 84095 | 2017-01-20 |
| 1306393889 | Tal Quirl | Optometrist | 3571 W. 10400 S., South Jordan, UT 84095 | 2016-09-01 |
| 1023562667 | Sevon Taroian | Social Worker | 11260 River Heights Drive, South Jordan, UT 84095 | 2016-08-11 |
| 1952762932 | Megan Buckley | Developmental Therapist | 881 Baxter Drive, Ste 100, South Jordan, UT 84095 | 2016-03-17 |
| Find all providers in zip 84095 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649892829 | Van Martin Stonehocker | Physician Assistant | 755 W Center St, Orem, UT 84057-5365 | 2020-05-11 |
| 1891230041 | Sarah Danielle Mendenhall | Physician Assistant | 5169 S Cottonwood St Ste 600, Murray, UT 84107-6771 | 2016-12-26 |
| 1104284124 | Amanda Cummings | Physician Assistant | 30 N 1900 E # 3b110, Salt Lake City, UT 84132-0002 | 2016-02-04 |
| 1043699101 | Chris Anderson | Physician Assistant | 30 North 1900 East #3c344, Salt Lake City, UT 84132 | 2015-05-22 |
| 1861895344 | Ariel Black | Physician Assistant | 30 N 1900 E # 3c344, Salt Lake City, UT 84132-0002 | 2014-09-29 |
| 1336493709 | Monica L Hatch | Physician Assistant | 2132 N 1700 W Ste 200, Layton, UT 84041-7060 | 2012-11-06 |
| 1912130311 | Andrew M Strong | Physician Assistant | 5323 Woodrow St Ste 202, Salt Lake City, UT 84107-5848 | 2009-09-01 |
| 1164666061 | Stephen A Loper | Physician Assistant | 1055 N 500 W Ste 211, Provo, UT 84604-3305 | 2009-04-23 |
| 1982869210 | Scott D Taylor | Physician Assistant | 5323 Woodrow St Ste 102, Murray, UT 84107-5853 | 2008-07-25 |
| 1255517488 | William R. Mathie | Physician Assistant | 1055 N 500 W Ste 121, Provo, UT 84604-3305 | 2008-01-17 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH JORDAN |
| Zip Code | 84095 |
Please comment or provide details below to improve the information on BROCK BODILY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.