Provider Demographics
NPI:1275975724
Name:ADDIS, KATE ALISON (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ALISON
Last Name:ADDIS
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 1:8990 UPPER LANDO LN
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5826
Mailing Address - Country:US
Mailing Address - Phone:702-525-8635
Mailing Address - Fax:
Practice Address - Street 1:1794 OLYMPIC PARK WAY SUITE #140
Practice Address - Street 2:SUITE #140
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-575-0345
Practice Address - Fax:435-575-0346
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10085314-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist