Healthcare Provider Details

I. General information

NPI: 1245163716
Provider Name (Legal Business Name): KAYLA PAIGE WATERMAN DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA PAIGE MILLER

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W BAXTER DR # 101
SOUTH JORDAN UT
84095-8687
US

IV. Provider business mailing address

6900 S 900 E STE 100
MIDVALE UT
84047-5820
US

V. Phone/Fax

Practice location:
  • Phone: 801-797-1998
  • Fax: 801-797-1945
Mailing address:
  • Phone: 801-890-6626
  • Fax: 801-432-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14289442-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: