Provider Demographics
NPI:1013366822
Name:LEDUC, KIMBERLEE A (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:A
Last Name:LEDUC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 S 1300 E STE W200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3775
Mailing Address - Country:US
Mailing Address - Phone:801-572-0690
Mailing Address - Fax:801-572-0696
Practice Address - Street 1:13348 S MARKET CENTER DR # 150
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8001
Practice Address - Country:US
Practice Address - Phone:801-302-8866
Practice Address - Fax:801-302-8868
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4822225100000X
UT9634765-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist