Healthcare Provider Details

I. General information

NPI: 1902313208
Provider Name (Legal Business Name): MAKRIZZEL GALVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRIZZEL GALVEZ MS, LAT, ATC

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S FASHION BLVD
MURRAY UT
84107-6157
US

IV. Provider business mailing address

5848 S FASHION BLVD
MURRAY UT
84107-6157
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: