Provider Demographics
NPI:1366034373
Name:CANTLEBARY, KATHERINE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CANTLEBARY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 WEST TERMINAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84122
Mailing Address - Country:US
Mailing Address - Phone:801-744-4008
Mailing Address - Fax:
Practice Address - Street 1:4051 WEST TERMINAL DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84122
Practice Address - Country:US
Practice Address - Phone:801-744-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11864570-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer