Healthcare Provider Details

I. General information

NPI: 1669926952
Provider Name (Legal Business Name): EMILY FRANCES TESON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 OLD MAIN HL
LOGAN UT
84322-7425
US

IV. Provider business mailing address

9319 ROBERT D SNYDER ROAD SUITE 416
CHARLOTTE NC
28223-0001
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5296
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: