Healthcare Provider Details

I. General information

NPI: 1336744580
Provider Name (Legal Business Name): CAMBRY GABRIELLA KINDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E 250 S HPER EAST, ROOM 208
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

5068 W CHARLENE LN
WEST VALLEY CITY UT
84120-4574
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1820
  • Fax:
Mailing address:
  • Phone: 801-696-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: