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Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1609245612

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
518 W 200 N  SMITHFIELD, UT 84335-6606 US
Tel: 435-563-2507  Fax: --

Contact information for business:
518 W 200 N  SMITHFIELD, UT 84335-6606 US
Tel: 435-563-2507  Fax: --

Registration Information:
NPI: 1609245612
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Athletic Trainer

Legacy codes, insurance codes and state license numbers:



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