Healthcare Provider Details

I. General information

NPI: 1164793501
Provider Name (Legal Business Name): CHRISTOPHER BARBER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2657 W 2375 N
CLINTON UT
84015-8296
US

IV. Provider business mailing address

2657 W 2375 N
CLINTON UT
84015-8296
US

V. Phone/Fax

Practice location:
  • Phone: 435-730-4261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8191922-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: