Individual
KAITLYN SHYANNE WININGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2180 E 4500 S, HOLLADAY, UT 84117-4434
(801) 592-6588
Mailing address
1126 E 1350 S, CLEARFIELD, UT 84015-1618
(801) 592-6588
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8457613-4701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177635649
DRIVER'S LICENSE
UT
01
—
9807712-0160
BUSINESS ENTITY NUMBER
UT
Enumeration date
09/15/2020
Last updated
09/15/2020
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