Basic Information
| Provider Information | |||||||||
| NPI: | 1104157221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENBURG | ||||||||
| FirstName: | KATHRINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 643 W 700 N STE C | ||||||||
| Address2: | |||||||||
| City: | LINDON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840421366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017960322 | ||||||||
| FaxNumber: | 8017961038 | ||||||||
| Practice Location | |||||||||
| Address1: | 643 W 700 N STE C | ||||||||
| Address2: | |||||||||
| City: | LINDON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840421366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017960322 | ||||||||
| FaxNumber: | 8017961038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2010 | ||||||||
| LastUpdateDate: | 01/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 3646644701 | UT | Y | Other Service Providers | Specialist |
No ID Information.