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General NPI Number Information
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NPI Number | 1063100683
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Entity Type | Individual
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Provider Name | KRISTIN FARRELL
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1420 S 500 W
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-5149
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Country | US
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Telephone | 352-316-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 S 500 W
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-5149
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 12468743
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12468743-4701
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License Number State | UT
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