Individual provider Active NPI

Kailey Skotak, DPT

  • Physical Therapist
  • Salt Lake City, UT
National Provider Identifier
1174158679
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14224776-2401 Issued in UT
Practice address
22 S 900 E
Salt Lake City, UT 84102-1307
Phone
(801) 758-0428
NPI assigned
Mar 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 14224776-2401 UT Primary

Addresses

Primary practice location

22 S 900 E
Salt Lake City, UT 84102-1307

Mailing address

22 S 900 E
Salt Lake City, UT 84102-1307
Phone (801) 758-0428

Other practice location 1

756 E 12200 S
Draper, UT 84020-9724
Phone (801) 758-0428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251027003598 UT Practitioner - Physical Therapist in Private Practice 9638507866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intermountain Ear Nose and Throat Specialists LLCGroup PAC ID 8022901610, 25 clinicians

Practice addresses (Care Compare)

22 S 900
Salt Lake City, UT 84102-1307
Phone (801) 328-2522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14224776-2401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Ear,Nose, and Throat Specialists LLC CurrentSince Aug 15, 2025 Accepting new patients

Locations

756 E 12200 S
Draper, UT 84020
Phone (801) 833-0579

4063 W 12600 S
Riverton, UT 84096
Phone (801) 495-4800

22 S 9th E
Slc, UT 84102
Phone (801) 328-7522

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1174158679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-758-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-758-0428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "756 E 12200 S",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840209724",
            "country_code": "US",
            "telephone_number": "801-758-0428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKOTAK",
        "first_name": "KAILEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-05",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "14224776-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.