Provider Demographics
NPI:1366238826
Name:ROBERTS, KYLIE (MA)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 W PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1389
Mailing Address - Country:US
Mailing Address - Phone:801-941-2533
Mailing Address - Fax:
Practice Address - Street 1:1667 W PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414-1389
Practice Address - Country:US
Practice Address - Phone:801-941-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer