Provider Demographics
NPI:1255098810
Name:ANDERSON, KAY RUTH (ATC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:RUTH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:RUTH
Other - Last Name:BELLVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14544 S RIVER CHASE RD
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5752
Mailing Address - Country:US
Mailing Address - Phone:801-599-9484
Mailing Address - Fax:
Practice Address - Street 1:14544 S RIVER CHASE RD
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5752
Practice Address - Country:US
Practice Address - Phone:801-599-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0496024022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer