Provider Demographics
NPI:1134659626
Name:TRUST, KELLY (ATC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRUST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4151 N TRAVERSE MOUNTAIN BLVD APT 15-303
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2646
Mailing Address - Country:US
Mailing Address - Phone:832-384-6127
Mailing Address - Fax:
Practice Address - Street 1:4151 N TRAVERSE MOUNTAIN BLVD APT 15-303
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2646
Practice Address - Country:US
Practice Address - Phone:832-384-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10272228-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer