Provider Demographics
NPI:1639943269
Name:CHRISTENSEN, KAITLIN (LMT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 GRAMERCY AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0740
Mailing Address - Country:US
Mailing Address - Phone:435-230-2964
Mailing Address - Fax:
Practice Address - Street 1:3113 GRAMERCY AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0740
Practice Address - Country:US
Practice Address - Phone:435-230-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12615179-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist