Provider Demographics
NPI:1811028277
Name:WESTLEN-BOYER, KARIN INGRID MARIA (PT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:INGRID MARIA
Last Name:WESTLEN-BOYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 N H ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3104
Mailing Address - Country:US
Mailing Address - Phone:801-557-2789
Mailing Address - Fax:
Practice Address - Street 1:4578 S HIGHLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4214
Practice Address - Country:US
Practice Address - Phone:801-557-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118628-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6422Medicaid
UTD6422Medicaid