Provider Demographics
NPI:1104581578
Name:HARVEY, KYLEE (LMT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 LORL LN APT 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8027
Mailing Address - Country:US
Mailing Address - Phone:801-458-0203
Mailing Address - Fax:
Practice Address - Street 1:707 24TH ST STE A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2580
Practice Address - Country:US
Practice Address - Phone:801-458-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10769047-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107690474701OtherTRIWEST