Healthcare Provider Details

I. General information

NPI: 1659348985
Provider Name (Legal Business Name): NATHAN WADE FELT A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 FASHION BLVD
MURRAY UT
84107-6121
US

IV. Provider business mailing address

6241 TURPIN ST
MURRAY UT
84107-7542
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4040
  • Fax:
Mailing address:
  • Phone: 801-602-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

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: