Basic Information
| Provider Information | |||||||||
| NPI: | 1912560368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | KELLY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RBT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGNESEN | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | KELLY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1443 W 800 N STE 103 | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840572878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016554950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4933 S 1500 W STE 210 | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844057738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018206420 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2019 | ||||||||
| LastUpdateDate: | 01/16/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 106S00000X | RBT-19-84528 | UT | Y |
No ID Information.