Provider Demographics
NPI:1831709963
Name:IVERS, KATHERINE (ATC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:IVERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 BROOK HOLLOW LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-8262
Mailing Address - Country:US
Mailing Address - Phone:435-659-0174
Mailing Address - Fax:
Practice Address - Street 1:7436 BROOK HOLLOW LOOP RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8262
Practice Address - Country:US
Practice Address - Phone:435-659-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer