Provider Demographics
NPI:1720566474
Name:CHRISTENSEN, KADE TAYLOR (ATC)
Entity Type:Individual
Prefix:
First Name:KADE
Middle Name:TAYLOR
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3368
Mailing Address - Country:US
Mailing Address - Phone:801-673-6913
Mailing Address - Fax:
Practice Address - Street 1:244 N FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-3368
Practice Address - Country:US
Practice Address - Phone:801-673-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20000334382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2000033438OtherBOARD OF CERTIFICATION