Provider Demographics
NPI:1699178889
Name:BAXTER, CARALYN (DPT)
Entity Type:Individual
Prefix:
First Name:CARALYN
Middle Name:
Last Name:BAXTER
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 1:1195 W BLACK ROCK TRL UNIT I
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-4609
Mailing Address - Country:US
Mailing Address - Phone:435-602-2672
Mailing Address - Fax:435-575-0346
Practice Address - Street 1:4554 FORESTDALE DR UNIT C16
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-1392
Practice Address - Country:US
Practice Address - Phone:603-568-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012851225100000X
UT9161032-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist