Healthcare Provider Details

I. General information

NPI: 1003772336
Provider Name (Legal Business Name): KAMRYN CURTIS LEISHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 S 600 W
LOGAN UT
84321-5026
US

IV. Provider business mailing address

186 S 600 W
LOGAN UT
84321-5026
US

V. Phone/Fax

Practice location:
  • Phone: 435-757-3244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number14247296-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: