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NPI Code Detail

MEDICARE: KRISTIN FARRELL

MEDICARE: KRISTIN FARRELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer12468743UT
2225700000XMassage Therapist12468743-4701UT

General Provider Information

NPI Number : 1063100683
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN FARRELL
Provider Business Mailing Address
First Line : 1420 S 500 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1420 S 500 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5149
Country : US
Telephone Number : 352-316-2160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2023
Last Update Date : 05/23/2023

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Directions to “ KRISTIN FARRELL ” Practice Location

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