Provider Demographics
NPI:1427494186
Name:POULSEN, KORY (RRT)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:POULSEN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 N HILL FIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6890
Mailing Address - Country:US
Mailing Address - Phone:801-825-0200
Mailing Address - Fax:801-266-0421
Practice Address - Street 1:2307 N HILL FIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6890
Practice Address - Country:US
Practice Address - Phone:801-825-0200
Practice Address - Fax:801-266-0421
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6209500-5701227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered