Provider Demographics
NPI:1346574001
Name:CERVANTES, CARRIE LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:CERVANTES
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 1:335 S 300 W
Mailing Address - Street 2:103
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1815
Mailing Address - Country:US
Mailing Address - Phone:801-546-6868
Mailing Address - Fax:801-546-8225
Practice Address - Street 1:335 N 300 W
Practice Address - Street 2:103
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1815
Practice Address - Country:US
Practice Address - Phone:801-546-6868
Practice Address - Fax:801-546-8225
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7305977-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist