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General NPI Number Information
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NPI Number | 1447660337
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Entity Type | Individual
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Provider Name | SEAN T KENDALL PA-C, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 389 S 900 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2310
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Country | US
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Telephone | 385-282-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 428 E DOWNINGTON AVE APT 1
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2256
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Country | US
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Telephone | 435-790-6320
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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 | 8001227-4810
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 8001227-1206
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8001227-1206
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License Number State | UT
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