Provider Demographics
NPI:1487339040
Name:BULLOCK, COLBY DEE (DPT)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:DEE
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 W 1850 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6162
Mailing Address - Country:US
Mailing Address - Phone:385-535-7181
Mailing Address - Fax:
Practice Address - Street 1:370 E SOUTH TEMPLE STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1279
Practice Address - Country:US
Practice Address - Phone:801-521-9222
Practice Address - Fax:801-521-9333
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13398778-8016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist