Healthcare Provider Details

I. General information

NPI: 1093268351
Provider Name (Legal Business Name): LAUREN NICOLE PABST AYALA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 W 12600 S
RIVERTON UT
84065-5577
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9854091-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: