Provider Demographics
NPI:1285321166
Name:WORTON, KRISTIN B (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:B
Last Name:WORTON
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 1:4032 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1858
Mailing Address - Country:US
Mailing Address - Phone:801-791-3711
Mailing Address - Fax:
Practice Address - Street 1:6033 FASHION POINT DR STE 120
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4850
Practice Address - Country:US
Practice Address - Phone:801-475-6800
Practice Address - Fax:801-475-6802
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5231823-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist