Healthcare Provider Details

I. General information

NPI: 1205355724
Provider Name (Legal Business Name): AARON D LEAVITT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY PKWY
OREM UT
84058-6703
US

IV. Provider business mailing address

800 W UNIVERSITY PKWY
OREM UT
84058-6703
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-6793
  • Fax:
Mailing address:
  • Phone: 801-863-6793
  • 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:

# 1
Identifier070502055
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBOC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: