Healthcare Provider Details

I. General information

NPI: 1477354330
Provider Name (Legal Business Name): KYLEE REBECCA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 24TH ST STE A
OGDEN UT
84401-4322
US

IV. Provider business mailing address

116 S LINDEN DR
LAYTON UT
84040-3915
US

V. Phone/Fax

Practice location:
  • Phone: 385-288-0807
  • Fax:
Mailing address:
  • Phone: 801-882-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1418244-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: