Healthcare Provider Details

I. General information

NPI: 1306753637
Provider Name (Legal Business Name): ERIC BONIN TRS, CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S HIGHLAND DR
MILLCREEK UT
84117-5108
US

IV. Provider business mailing address

6773 S OLIVET DR
SALT LAKE CITY UT
84121-2712
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-1892
  • Fax:
Mailing address:
  • Phone: 732-618-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14241803-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: