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General NPI Number Information
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NPI Number | 1700746450
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Entity Type | Organization
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Legal Business Name | KEN CARYL 904 INC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 12482 W KEN CARYL AVE UNIT A5
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City | LITTLETON
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State | CO
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Zip | 80127-3724
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Country | US
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Telephone | 720-574-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 5544 S GREEN ST
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City | MURRAY
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State | UT
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Zip | 84123-5798
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Country | US
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Telephone | 801-313-8000
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Fax |
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | PATRICE VINCENT
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Credential |
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Telephone | 801-313-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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