Healthcare Provider Details

I. General information

NPI: 1790888394
Provider Name (Legal Business Name): KIMBERLY ANN HOTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E
NORTH LOGAN UT
84341-6000
US

IV. Provider business mailing address

2380 N 400 E
NORTH LOGAN UT
84341-6000
US

V. Phone/Fax

Practice location:
  • Phone: 435-713-9700
  • Fax: 435-753-2986
Mailing address:
  • Phone: 435-713-9700
  • Fax: 435-753-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number48808192401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: