Healthcare Provider Details

I. General information

NPI: 1922967934
Provider Name (Legal Business Name): KAITLIN LA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 S HIGHLAND DR STE 180
SALT LAKE CITY UT
84117-4236
US

IV. Provider business mailing address

3074 W CHALK CREEK WAY
SOUTH JORDAN UT
84095-7969
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-0257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number142245782401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: