Provider Demographics
NPI:1275563579
Name:WHIPPLE, KEVAN L (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:L
Last Name:WHIPPLE
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 1:397 N WILLOW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3091
Mailing Address - Country:US
Mailing Address - Phone:801-215-9447
Mailing Address - Fax:801-618-0920
Practice Address - Street 1:15 S 1000 E STE 225
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5593
Practice Address - Country:US
Practice Address - Phone:801-609-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5162373-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU00007725Medicare UPIN