Provider Demographics
NPI:1447305875
Name:PROCINO, KAREN JOAN (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JOAN
Last Name:PROCINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682226
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-2226
Mailing Address - Country:US
Mailing Address - Phone:435-645-9095
Mailing Address - Fax:435-645-9092
Practice Address - Street 1:2015 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7323
Practice Address - Country:US
Practice Address - Phone:435-645-9095
Practice Address - Fax:435-645-9092
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2832592401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist