Healthcare Provider Details

I. General information

NPI: 1720566474
Provider Name (Legal Business Name): KADE TAYLOR CHRISTENSEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RENAISSANCE TOWNE DR STE 350
BOUNTIFUL UT
84010-7674
US

IV. Provider business mailing address

244 N FAIRWAY DR
NORTH SALT LAKE UT
84054-3368
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-3553
  • Fax: 801-295-3599
Mailing address:
  • Phone: 801-673-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10938166-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000033438
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: