Healthcare Provider Details

I. General information

NPI: 1912560368
Provider Name (Legal Business Name): RACHEL KELLY PERKINS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL KELLY MAGNESEN

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S 250 W APT 2
WASHINGTON TERRACE UT
84405-6466
US

IV. Provider business mailing address

1443 W 800 N STE 103
OREM UT
84057-2878
US

V. Phone/Fax

Practice location:
  • Phone: 435-632-6904
  • Fax:
Mailing address:
  • Phone: 801-655-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-84528
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: