Provider Demographics
NPI:1780091942
Name:KAISER, DAVID ALLEN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:KAISER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 WSC
Mailing Address - Street 2:BRIGHAM YOUNG UNIVERSITY
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-7900
Mailing Address - Country:US
Mailing Address - Phone:801-422-1627
Mailing Address - Fax:801-422-0398
Practice Address - Street 1:3328 WSC
Practice Address - Street 2:BRIGHAM YOUNG UNIVERSITY
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-7900
Practice Address - Country:US
Practice Address - Phone:801-422-1627
Practice Address - Fax:801-422-0398
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6640029-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer