Healthcare Provider Details

I. General information

NPI: 1336061951
Provider Name (Legal Business Name): KATELYN MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 S PIONEER PKWY STE 101
WEST VALLEY UT
84120-2067
US

IV. Provider business mailing address

3336 S PIONEER PKWY STE 101
WEST VALLEY UT
84120-2067
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-3903
  • Fax:
Mailing address:
  • Phone: 801-964-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: