Provider Demographics
NPI:1396599528
Name:WEBSTER, KAITLIN (DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E CENTER ST STE 103
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6743
Mailing Address - Country:US
Mailing Address - Phone:435-674-2115
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 103
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6743
Practice Address - Country:US
Practice Address - Phone:435-674-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist