Provider Demographics
NPI:1992201768
Name:ALVORD, KELLY (PT)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:
Last Name:ALVORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 W 570 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1343
Mailing Address - Country:US
Mailing Address - Phone:801-367-5555
Mailing Address - Fax:
Practice Address - Street 1:575 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7707
Practice Address - Country:US
Practice Address - Phone:801-225-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3409592401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist