MEDICARE: KAITLIN LA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	142245782401	UT

General Provider Information

NPI Number	:	1922967934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN LA

Provider Business Mailing Address
First Line	:	3074 W CHALK CREEK WAY
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-7969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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Directions to “ KAITLIN LA ” Practice Location

Language	Start Address	Practice Location

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