Basic Information
| Provider Information | |||||||||
| NPI: | 1659706273 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KNIGHT | ||||||||
| FirstName: | KAILYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1952 E FORT UNION BLVD | ||||||||
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| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014568409 | ||||||||
| FaxNumber: | 8014568413 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 DURYEA ST | ||||||||
| Address2: | |||||||||
| City: | RAYMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985771718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606286356 | ||||||||
| FaxNumber: | 3609420094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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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 | 225700000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225700000X | MA 60411438 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.