Healthcare Provider Details

I. General information

NPI: 1558172239
Provider Name (Legal Business Name): GRACE TRUAX ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14787 S ACADEMY PKWY
HERRIMAN UT
84096-2077
US

IV. Provider business mailing address

2150 S MCCLELLAND ST APT 418
SALT LAKE CITY UT
84106-6212
US

V. Phone/Fax

Practice location:
  • Phone: 385-434-3118
  • Fax:
Mailing address:
  • Phone: 708-790-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number14290378-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: