1225149099 NPI number — MRS. KIMBERLEE JACOB HATTON MPT

Table of content: MRS. KIMBERLEE JACOB HATTON MPT (NPI 1225149099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225149099 NPI number — MRS. KIMBERLEE JACOB HATTON MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATTON
Provider First Name:
KIMBERLEE
Provider Middle Name:
JACOB
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOB
Provider Other First Name:
KIMBERLEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225149099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5121 S COTTONWOOD ST
Provider Second Line Business Mailing Address:
INTERMOUNTAIN MEDICAL CENTER, ACUTE REHAB THERAPIES
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-507-7578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5121 S COTTONWOOD ST
Provider Second Line Business Practice Location Address:
INTERMOUNTAIN MEDICAL CENTER, ACUTE REHAB THERAPIES
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-7578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00008326 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 341950-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)