Healthcare Provider Details

I. General information

NPI: 1457760902
Provider Name (Legal Business Name): FRANK D HOLOWKA LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 S 1000 E
CLEARFIELD UT
84015-1837
US

IV. Provider business mailing address

1302 E 5100 S
SOUTH OGDEN UT
84403-4265
US

V. Phone/Fax

Practice location:
  • Phone: 801-402-8200
  • Fax:
Mailing address:
  • Phone: 801-605-3951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number9034749-4810
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: