Provider Demographics
NPI:1396249868
Name:PERKINS, KATHRYN (LMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 S CLARE DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-5759
Mailing Address - Country:US
Mailing Address - Phone:801-834-4068
Mailing Address - Fax:
Practice Address - Street 1:1104 E ASHTON AVE STE 118
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2348
Practice Address - Country:US
Practice Address - Phone:801-834-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5819755-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist